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Published in: Diseases of the Colon & Rectum 1/2007

01-01-2007

Factors Affecting Circumferential Resection Margin Involvement After Rectal Cancer Excision

Authors: Henry S. Tilney, M.R.C.S., Paris P. Tekkis, M.D., F.R.C.S., Parvinder S. Sains, M.R.C.S., Vasilis A. Constantinides, B.Sc., M.B.B.S., Alexander G. Heriot, M.D., F.R.C.S., on behalf of the Association of Coloproctology of Great Britain and Ireland

Published in: Diseases of the Colon & Rectum | Issue 1/2007

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Purpose

This study was designed to assess factors affecting rates of circumferential resection margin involvement after rectal cancer excision, the association between circumferential resection margin involvement rates for patients undergoing anterior resection and abdominoperineal excision within the same unit, and trends in outcomes between units.

Methods

Data about patients undergoing rectal cancer excision between 2000 and 2003 were extracted from the Association of Coloproctology of Great Britain and Ireland database. Multivariate logistic regression analysis was used to identify independent predictors of circumferential resection margin involvement. Pearson correlation coefficient was used to evaluate the association between circumferential resection margin involvement for anterior resection and abdominoperineal excision.

Results

A total of 1,430 patients satisfied the inclusion criteria. The circumferential resection margin involvement rate for anterior resection (n=794) was 6.7 percent, between hospital variability was 0 to 40 percent, and for abdominoperineal excision (n=521) was 17.6 percent, between hospital variability 0 to 100 percent. Independent predictors of circumferential resection margin involvement were T stage (P<0.001), nodal involvement (P=0.007), and operative procedure (P<0.001). Units with a high circumferential resection margin involvement rate for anterior resection also had a high circumferential resection margin involvement rate for abdominoperineal excision (Pearson correlation=0.349; P=0.01).

Conclusions

Circumferential resection margin involvement is more common in lymph-node-positive tumors and is more common after abdominoperineal excision compared with anterior resection. This relationship was consistent across units irrespective of their individual circumferential resection margin involvement rates.
Literature
1.
go back to reference Ueno, H, Mochizuki, H, Hashiguchi, Y, Hase, K 2001Prognostic determinants of patients with lateral nodal involvement by rectal cancerAnn Surg234190197PubMedCrossRef Ueno, H, Mochizuki, H, Hashiguchi, Y, Hase, K 2001Prognostic determinants of patients with lateral nodal involvement by rectal cancerAnn Surg234190197PubMedCrossRef
2.
go back to reference Adam, IJ, Mohamdee, MO, Martin, IG, et al. 1994Role of circumferential margin involvement in the local recurrence of rectal cancerLancet344707711PubMedCrossRef Adam, IJ, Mohamdee, MO, Martin, IG,  et al. 1994Role of circumferential margin involvement in the local recurrence of rectal cancerLancet344707711PubMedCrossRef
3.
go back to reference Hall, NR, Finan, PJ, al-Jaberi, T, et al. 1998Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence?Dis Colon Rectum41979983PubMedCrossRef Hall, NR, Finan, PJ, al-Jaberi, T,  et al. 1998Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence?Dis Colon Rectum41979983PubMedCrossRef
4.
go back to reference Heald, RJ 1979A new approach to rectal cancerBr J Hosp Med22277281PubMed Heald, RJ 1979A new approach to rectal cancerBr J Hosp Med22277281PubMed
5.
go back to reference Heald, RJ 1995Total mesorectal excision is optimal surgery for rectal cancer: a Scandinavian consensusBr J Surg8212971299PubMed Heald, RJ 1995Total mesorectal excision is optimal surgery for rectal cancer: a Scandinavian consensusBr J Surg8212971299PubMed
6.
go back to reference Nagtegaal, ID, Krieken, JH 2002The role of pathologists in the quality control of diagnosis and treatment of rectal cancer-an overviewEur J Cancer38964972PubMedCrossRef Nagtegaal, ID, Krieken, JH 2002The role of pathologists in the quality control of diagnosis and treatment of rectal cancer-an overviewEur J Cancer38964972PubMedCrossRef
7.
go back to reference Colorectal Cancer Collaborative Group2001Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trialsLancet35812911304CrossRef Colorectal Cancer Collaborative Group2001Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trialsLancet35812911304CrossRef
8.
go back to reference Kapiteijn, E, Marijnen, CA, Nagtegaal, ID, et al. 2001Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancerN Engl J Med345638646PubMedCrossRef Kapiteijn, E, Marijnen, CA, Nagtegaal, ID,  et al. 2001Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancerN Engl J Med345638646PubMedCrossRef
9.
go back to reference Dahlberg, M, Glimelius, B, Graf, W, Pahlman, L 1998Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized studyDis Colon Rectum41543551PubMedCrossRef Dahlberg, M, Glimelius, B, Graf, W, Pahlman, L 1998Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized studyDis Colon Rectum41543551PubMedCrossRef
10.
go back to reference Peeters, KC, Velde, CJ, Leer, JW, et al. 2005Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients–a Dutch colorectal cancer group studyJ Clin Oncol2361996206PubMedCrossRef Peeters, KC, Velde, CJ, Leer, JW,  et al. 2005Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients–a Dutch colorectal cancer group studyJ Clin Oncol2361996206PubMedCrossRef
11.
go back to reference Heriot, AG, Tekkis, PP, Fazio, VW, Neary, P, Lavery, IC 2005Adjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancer: a predictive modelAnn Surg242502511PubMed Heriot, AG, Tekkis, PP, Fazio, VW, Neary, P, Lavery, IC 2005Adjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancer: a predictive modelAnn Surg242502511PubMed
12.
go back to reference Edwards, DP, Mortensen, NJ 2001Is radiotherapy for rectal cancer indicated if surgery is optimized?Eur J Surg Oncol27442445PubMedCrossRef Edwards, DP, Mortensen, NJ 2001Is radiotherapy for rectal cancer indicated if surgery is optimized?Eur J Surg Oncol27442445PubMedCrossRef
13.
go back to reference Brown, G, Radcliffe, AG, Newcombe, RG, Dallimore, NS, Bourne, MW, Williams, GT 2003Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imagingBr J Surg90355364PubMedCrossRef Brown, G, Radcliffe, AG, Newcombe, RG, Dallimore, NS, Bourne, MW, Williams, GT 2003Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imagingBr J Surg90355364PubMedCrossRef
14.
go back to reference Seow-Choen, F 2002Adjuvant therapy for rectal cancer cannot be based on the results of other surgeonsBr J Surg89946947PubMedCrossRef Seow-Choen, F 2002Adjuvant therapy for rectal cancer cannot be based on the results of other surgeonsBr J Surg89946947PubMedCrossRef
15.
go back to reference Tekkis, PP, Heriot, AG, Smith, J, Thompson, MR, Finan, P, Stamatakis, JD 2005Comparison of circumferential margin involvement between restorative and nonrestorative resections for rectal cancerColorectal Dis7369374PubMedCrossRef Tekkis, PP, Heriot, AG, Smith, J, Thompson, MR, Finan, P, Stamatakis, JD 2005Comparison of circumferential margin involvement between restorative and nonrestorative resections for rectal cancerColorectal Dis7369374PubMedCrossRef
16.
go back to reference The Association of Coloproctology of Great Britain and Ireland Database and Dataset. In. Version 2 for Access 2000 UK ed: Clin IT 2000; 2000. The Association of Coloproctology of Great Britain and Ireland Database and Dataset. In. Version 2 for Access 2000 UK ed: Clin IT 2000; 2000.
17.
go back to reference Quirke, P, Durdey, P, Dixon, MF, Williams, NS 1986Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excisionLancet2996999PubMedCrossRef Quirke, P, Durdey, P, Dixon, MF, Williams, NS 1986Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excisionLancet2996999PubMedCrossRef
18.
go back to reference Quirke, P, Dixon, MF 1988The prediction of local recurrence in rectal adenocarcinoma by histopathological examinationInt J Colorectal Dis3127131PubMedCrossRef Quirke, P, Dixon, MF 1988The prediction of local recurrence in rectal adenocarcinoma by histopathological examinationInt J Colorectal Dis3127131PubMedCrossRef
19.
go back to reference Beets-Tan, RG, Beets, GL 2004Rectal cancer: review with emphasis on MR imagingRadiology232335346PubMed Beets-Tan, RG, Beets, GL 2004Rectal cancer: review with emphasis on MR imagingRadiology232335346PubMed
20.
go back to reference Will, O, Purkayastha, S, Chan, C, et al. 2006Diagnostic precision of nanoparticle-enhanced MRI for lymph-node metastases: a meta-analysisLancet Oncol75260PubMedCrossRef Will, O, Purkayastha, S, Chan, C,  et al. 2006Diagnostic precision of nanoparticle-enhanced MRI for lymph-node metastases: a meta-analysisLancet Oncol75260PubMedCrossRef
21.
go back to reference Enker, WE, Havenga, K, Polyak, T, Thaler, H, Cranor, M 1997Abdominoperineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancerWorld J Surg21715720PubMedCrossRef Enker, WE, Havenga, K, Polyak, T, Thaler, H, Cranor, M 1997Abdominoperineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancerWorld J Surg21715720PubMedCrossRef
22.
go back to reference Lopez-Kostner, F, Lavery, I, Hool, G, Rybicki, L, Fazio, V 1998Total mesorectal excision is not necessary for cancers of the upper rectumSurgery124612618PubMedCrossRef Lopez-Kostner, F, Lavery, I, Hool, G, Rybicki, L, Fazio, V 1998Total mesorectal excision is not necessary for cancers of the upper rectumSurgery124612618PubMedCrossRef
23.
go back to reference Luna-Perez, P, Rodriguez-Ramirez, S, Vega, J, Sandoval, E, Labastida, S 2001Morbidity and mortality following abdominoperineal resection for low rectal adenocarcinomaRev Invest Clin53388395PubMed Luna-Perez, P, Rodriguez-Ramirez, S, Vega, J, Sandoval, E, Labastida, S 2001Morbidity and mortality following abdominoperineal resection for low rectal adenocarcinomaRev Invest Clin53388395PubMed
24.
go back to reference Arbman, G, Nilsson, E, Hallbook, O, Sjodahl, R 1996Local recurrence following total mesorectal excision for rectal cancerBr J Surg83375379PubMed Arbman, G, Nilsson, E, Hallbook, O, Sjodahl, R 1996Local recurrence following total mesorectal excision for rectal cancerBr J Surg83375379PubMed
26.
go back to reference Killeen, SD, O’Sullivan, MJ, Coffey, JC, Kirwan, WO, Redmond, HP 2005Provider volume and outcomes for oncological proceduresBr J Surg92389402PubMedCrossRef Killeen, SD, O’Sullivan, MJ, Coffey, JC, Kirwan, WO, Redmond, HP 2005Provider volume and outcomes for oncological proceduresBr J Surg92389402PubMedCrossRef
27.
go back to reference Konety, BR, Dhawan, V, Allareddy, V, Joslyn, SA 2005Impact of hospital and surgeon volume on in-hospital mortality from radical cystectomy: data from the health care utilization projectJ Urol17316951700PubMedCrossRef Konety, BR, Dhawan, V, Allareddy, V, Joslyn, SA 2005Impact of hospital and surgeon volume on in-hospital mortality from radical cystectomy: data from the health care utilization projectJ Urol17316951700PubMedCrossRef
28.
go back to reference Ellison, LM, Trock, BJ, Poe, NR, Partin, AW 2005The effect of hospital volume on cancer control after radical prostatectomyJ Urol17320942098PubMedCrossRef Ellison, LM, Trock, BJ, Poe, NR, Partin, AW 2005The effect of hospital volume on cancer control after radical prostatectomyJ Urol17320942098PubMedCrossRef
Metadata
Title
Factors Affecting Circumferential Resection Margin Involvement After Rectal Cancer Excision
Authors
Henry S. Tilney, M.R.C.S.
Paris P. Tekkis, M.D., F.R.C.S.
Parvinder S. Sains, M.R.C.S.
Vasilis A. Constantinides, B.Sc., M.B.B.S.
Alexander G. Heriot, M.D., F.R.C.S.
on behalf of the Association of Coloproctology of Great Britain and Ireland
Publication date
01-01-2007
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 1/2007
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-006-0744-6

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