Prognostic significance of radial margins of clearance in rectal cancer

AimThis study aimed to investigate circumferential resection margin (CRM) as a prognostic factor for long‐term oncologic survival after rectal cancer surgery.MethodsPatients diagnosed with malignant rectal cancer between 1 January 2010 and 31 December 2014, from the Surveillance, Epidemiology, and End Results (SEER) program were identified for this study. The patients were divided into five CRM groups to compare the baseline characteristics and assess cancer‐specific survival (CSS): 0‐1 mm, 1.1‐2.0 mm, 2.1‐5.0 mm, 5.1‐10.0 mm, and >10 mm. The main endpoint was CSS.ResultsCircumferential resection margin ≤1 mm was independently associated with 99% increased risk of cancer‐specific mortality in rectal cancer [hazard ratio (HR) = 1.990, 95% confidence interval (CI) = 1.613‐2.454, P < 0.001, using CRM (1.1‐2.0 mm) as a reference]. CRM (5.1‐10.0 mm) was independently associated with 29.2% decreased risk of cancer‐specific mortality [HR = 0.708, 95% CI = 0.525‐0.954, P = 0.152, using group (2.1‐5.0 mm) as reference]. CRM ≤2 mm or ≤0.4 mm was not obviously associated with CSS.Conclusionscircumferential resection margin is an independent prognostic factor in rectal cancer. Surgeons should try to maximize the CRM. Rectal cancer patients with CRM ≤1 mm should receive more postoperative attention depending on individual situation. Also, CRM should be accurately measured in millimeters in a preoperative magnetic resonance imaging or pathological report, rather than simply described as “involved” or “clear.”

show abstract

“…This is consistent with most studies on the prognostic prediction of CRM 6, 7, 8, 12, 13, 14, 15, 16…”

Section: Discussionsupporting

confidence: 92%

“…Many studies considered CRM as positive when it was ≤1 mm (R1) and associated with obviously poor prognosis as compared to CRM >1 mm (R0), which was in accordance with the ESMO guidelines 6, 8, 12, 13, 14, 15, 16, 17. The criterion to define a positive CRM remains unclear.…”

Section: Introductionmentioning

confidence: 75%

Circumferential resection margin as a prognostic factor after rectal cancer surgery: A large population‐based retrospective study

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Several factors seem to determine tumor regression after preoperative radiotherapy, including fraction size and total dose applied. 25,32 In randomized studies with a dose of no more than 20 Gy, no downstaging or complete histological tumor regression was found. 24,32 Tumor regression was reported with a total radiation dose exceeding 20 Gy.…”

Section: Radiotherapy In Rectal Cancer (Bouzourene Et Al)mentioning

confidence: 99%

“…We first paid attention to factors known to adversely influence the risk of local recurrence or survival in rectal cancer treated with surgery alone, including such tumor characteristics as tumor stage, differentiation grade, tumor type, lymphatic or venous invasion, RRM, and clearance. 11,24,25 We also looked at the prognostic role of tumor regression in rectal cancers preoperatively treated by HART. We found in this study, as in a previously reported study, 10 that advanced pT was associated with a decreased DFS.…”

Section: Radiotherapy In Rectal Cancer (Bouzourene Et Al)mentioning

confidence: 99%

Predictive factors in locally advanced rectal cancer treated with preoperative hyperfractionated and accelerated radiotherapy

Bouzourène¹,

Bosman²,

Matter

et al. 2003

Human Pathology

View full text Add to dashboard Cite

Colorectal cancer is a significant cause of morbidity and mortality in Western populations. More than 1/3 of cases occur in the rectum, with an outcome after surgery less favorable than for colon cancer, as reflected in local recurrence rates of 20% to 50% after traditional surgical treatment. 1 Moreover, rectal cancer is characterized by a higher incidence of regional lymph nodes and distant metastases. Preoperative radiotherapy has been shown to reduce local failure rates and to improve overall survival. 1-4 However, results of different clinicopathologic studies are sometimes contradictory, which might be related to the heterogeneity in radiation treatment-related factors and clinical stages. Absence of a standardized method for pathologic analysis might be another source of discrepancies.We have adopted a treatment schedule that aims to accelerate the treatment to counter tumor proliferation during treatment and to reduce the risk of late complications by hyperfractionation (ie, reducing the dose per fraction). This hyperfractionated accelerated radiotherapy (HART) schedule was tested in locally advanced rectal cancer, that is, T3 and T4 and any N, or any T but Nϩ, rectal cancers. 5,6 We demonstrated that preoperative HART is feasible and is associated with a lower toxicity than postoperative radiotherapy. 5 Based on this initial experience, a phase II trial was initiated.Whether or not classical predictive factors of survival for colorectal cancer are still important after neoadjuvant therapy is a question frequently asked by pathologists, and only sporadic studies with a systematic pathologic approach try to answer it. In this study we attempted to correlate response to radiotherapy with pathologic variables and to determine which pathologic variables, including histological assessment of response to radiotherapy, correlated with disease outcome. PATIENTS AND METHODSThe study group comprised 104 patients with locally advanced rectal cancer recruited in a phase II trial (93-01) on preoperative HART between 1992 and 1998. Assessment of the clinical stage was based on digital rectal examination, completed by both rectal ultrasonography and computed tomography (CT) scan. During this time period, all patients were eligible if they presented at preoperative work-up with cT3 or cT4, regardless of the N stage. The HART protocol was reviewed by the local ethics committee. All patients gave informed consent. Patients with coexisting cancer or chronic

show abstract

“…Apesar deste fato, o envolvimento da margem distal de ressecção está associado à recidiva local, sendo considerado a principal causa mencionada em algumas séries na literatura. (25,26,27,28) A taxa de ressecabilidade nas cirurgias para recidiva pélvica foi de 65,4%, próximo ao encontrado por Bedrosin e col. (29) , que verificaram aproximadamente 60% de ressecabilidade nestes casos, e superior ao referido por Boyle e col. (7) , (36,8%).…”

Section: Figura 1 -Cirurgias Realizadas Inicialmente Para Abordagem Dunclassified

Recidiva pélvica de adenocarcinoma de reto: abordagem cirúrgica

Leal

Ayrizono

Fagundes

et al. 2008

Rev bras. colo-proctol.

View full text Add to dashboard Cite

Descritores: Adenocarcinoma retal; recidiva local; cirurgia pélvica. Trabalho realizado pelo Grupo de Coloproctologia, Disciplina de Moléstias do Aparelho Digestório, (DMAD), Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas INTRODUÇÃOA recidiva pélvica do câncer do reto constitui grande desafio no seu tratamento, podendo cursar com altas taxas de morbimortalidade, envolvendo elevado custo econômico. A ressecção cirúrgica do segmento acometido com adenocarcinoma retal aliada à excisão total do mesorreto (ETM), além da neoadjuvância, tem sido preconizada para o tratamento desta afecção, com redução das taxas de recidiva local. (1,2,3,4,5,6) No entanto, a recidiva pélvica após ressecção curativa do câncer retal, continua influenciando na sobrevida dos doentes, e constituindo importante causa de morbidade pós-operatória. Entre 3% a 35% dos doentes evoluirão com recidiva local. (3,5,6,7,8) Os fatores que estão implicados nas diferentes taxas de recidiva observadas na literatura, são aqueles relacionados à técnica operatória e à própria biologia do tumor. O estadiamento inicial da neoplasia é um dos fatores relacionados à biologia tumoral, sendo considerado o mais importante. (7) Outros, como margem cirúrgica, distân-

show abstract

Prognostic significance of radial margins of clearance in rectal cancer

Cited by 209 publications

References 18 publications

Circumferential resection margin as a prognostic factor after rectal cancer surgery: A large population‐based retrospective study

Circumferential resection margin as a prognostic factor after rectal cancer surgery: A large population‐based retrospective study

Predictive factors in locally advanced rectal cancer treated with preoperative hyperfractionated and accelerated radiotherapy

Recidiva pélvica de adenocarcinoma de reto: abordagem cirúrgica

Contact Info

Product

Resources

About