Top

Published in:

01-02-2007

Prognostic Significance of Circumferential Resection Margin Following Total Mesorectal Excision and Adjuvant Chemoradiotherapy in Patients with Rectal Cancer

Published in: Annals of Surgical Oncology | Issue 2/2007

Abstract

Background

This study was designed to evaluate the prognostic value of circumferential resection margin (CRM) in rectal cancer patients who underwent curative resection with adjuvant chemoradiotherapy (CRT).

Methods

We studied 504 patients who underwent total mesorectal excision with adjuvant CRT for rectal cancer between 1997 and 2001. The patients were divided into two groups: a negative CRM group (CRM > 1 mm) and a positive CRM group (CRM ≤ 1 mm). The survival rates, local recurrence rates, and systemic recurrence rates were compared between groups.

Results

The negative CRM group had 460 patients and the positive CRM group had 44 patients. The 5-year local and systemic recurrence rates were 11.3 and 25.3%, respectively, in the negative CRM group and 35.2 and 60.8% in the positive CRM group, respectively. The cancer-specific 5-year survival rates for the two groups were 72.5 and 26.9% (P < .001), respectively. CRM was found to be an independent prognostic factor by multivariate analyses which were adjusted for known outcome predictors (P < .001).

Conclusion

Oncological outcome for patients in the positive CRM group is less favorable than for those in the negative CRM group. Adjuvant CRT is not a definite treatment modality that can be used to compensate for a positive CRM following TME and adjuvant CRT in patients with TNM stage II or III rectal cancer.

Nymann T, Jess P, Christiansen J. Rate and treatment of pelvic recurrence after abdominoperineal resection and low anterior resection for rectal cancer. Dis Colon Rectum 1995; 38:799–802PubMedCrossRef

Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 1984; 53:1354–62PubMedCrossRef

Pahlman L, Glimelius B. Local recurrences after surgical treatment for rectal carcinoma. Acta Chir Scand 1984; 150:331–5PubMed

Heald RJ. A new approach to rectal cancer. Br J Hosp Med 1979; 22:277–81PubMed

Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1987–1997. Arch Surg 1998; 133:894–9PubMedCrossRef

Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 1995; 181;335–46PubMed

Heald RJ, Ryall RD. Recurrence, survival after total mesorectal excision for rectal cancer. Lancet 1986; I:1479–82CrossRef

Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 1982; 69:613–6PubMedCrossRef

Frykholm GJ, Glimelius B, Pahlman L. Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effects. Dis Colon Rectum 1993; 36:564–72PubMedCrossRef

10.

Treurniet-Donker AD, van Putten WL, Wereldsma JC, et al. Postoperative radiation therapy for rectal cancer. An interim analysis of a prospective, randomized multicenter trial in The Netherlands. Cancer 1991; 67:2042–8PubMedCrossRef

11.

Birbeck KF, Macklin CP, Tiffin NJ, et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 2002; 235:449–57PubMedCrossRef

12.

Cawthorn SJ, Parums DV, Gibbs NM, A’Hern RP, Caffarey SM, Broughton CI, Marks CG. Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer. Lancet 1990; 335:1055–9PubMedCrossRef

13.

Wibe A, Rendedal PR, Svensson E, Norstein J, Eide TJ, Myrvold HE, Soreide O. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 2003; 89:327–34CrossRef

14.

Marijnen CA, Nagtegaal ID, Kapiteijn E, et al. Radotherapy does not compensate for positive resection margin in rectal cancer patients: report of a multicenter radomized trial. Int J Radiat Oncol Biol Phys 2003; 55:1311–20PubMed

15.

Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual, 6th edn. New York: Springer-Verlag (2002)

16.

NIH consensus conference: adjuvant therapy for patients with colon and rectal cancer. JAMA 1990; 264:1444–50CrossRef

17.

Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumor spread and surgical excision. Lancet 1986; 2:996–9PubMedCrossRef

18.

Adam IJ, Mohamdee MO, Martin IG, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 1994; 344:701–11CrossRef

19.

Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for respectable rectal cancer. N Engl J Med 2001; 345:638–6PubMedCrossRef

20.

Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351:1731–40PubMedCrossRef

21.

Wiggers T, van de Velde CJ. The circumferential margin in rectal cancer: recommendations based on the Dutch Total Mesorectal Excision Study. Eur J Cancer 2002; 38:973–6PubMedCrossRef

22.

Compton C, Fenoglio-Preiser CM, Pettigrew N, Fielding LP. American Joint Committee on Cancer prognostic factors consensus conference: colorectal working group. Cancer 2000; 88:1739–57PubMedCrossRef

23.

Nagtegaal ID, Marijnen CA, Kranenbarg EK, van de Velde CJ, van Krieken JH, Pathology Review Committee; Cooperative Clinical Investigators. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 2002; 26:350–7PubMedCrossRef

24.

Zhu AX, Willett CG. Combined modality treatment for rectal cancer. Semin Oncol 2005; 32:103–12PubMedCrossRef

25.

Kim NK, Kim MJ, Park JK, Park SI, Min JS. Preoperative staging of rectal cancer with MRI: accuracy and clinical usefulness. Ann Surg Oncol 2000; 7:732–7PubMedCrossRef

26.

Martling A, Holm T, Bremmer S, Lindholm J, Cedermark B, Blomqvist L. Prognostic value of preoperative magnetic resonance imaging of the pelvis in rectal cancer. Br J Surg 2003; 90:1422–8PubMedCrossRef

27.

Beets-Tan RG. MRI in rectal cancer: the T stage and circumferential resection margin. Colorectal Dis 2003; 5:392–5PubMedCrossRef

28.

Beets-Tan RG, Beets GL, Vliegen RF, et al. Accuracy of magnetic resonance imaging in rectal cancer surgery. Lancet 2001; 357:497–504PubMedCrossRef

Title: Prognostic Significance of Circumferential Resection Margin Following Total Mesorectal Excision and Adjuvant Chemoradiotherapy in Patients with Rectal Cancer
Publication date: 01-02-2007
Published in: Annals of Surgical Oncology / Issue 2/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-006-9171-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Prognostic Significance of Circumferential Resection Margin Following Total Mesorectal Excision and Adjuvant Chemoradiotherapy in Patients with Rectal Cancer

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2007

Local/Cervical Block Anesthesia versus General Anesthesia for Minimally Invasive Parathyroidectomy: What are the Advantages?

Can Surgical Oncologists Reliably Predict the Likelihood for Non-SLN Metastases in Breast Cancer Patients?

Local Involvement of the Urinary Bladder in Primary Colorectal Cancer: Outcome with En Bloc Resection

Molecular Prognostic Factors in Adenocarcinoma of the Esophagus and Gastroesophageal Junction

Influence of Overweight on Surgical Complications for Gastric Cancer: Results From a Randomized Control Trial Comparing D2 and Extended Para-aortic D3 Lymphadenectomy (JCOG9501)

Surgical Treatment of Solitary Thyroid Nodules Via Fine-Needle Aspiration Biopsy and Frozen-Section Analysis