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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2013

01-04-2013 | Colorectal Cancer

What is the Significance of the Circumferential Margin in Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiotherapy?

Authors: Atthaphorn Trakarnsanga, MD, Mithat Gonen, PhD, Jinru Shia, MD, Karyn A. Goodman, MD, Garrett M. Nash, MD, Larissa K. Temple, MD, José G. Guillem, MD, Philip B. Paty, MD, Julio Garcia-Aguilar, MD, Martin R. Weiser, MD, FACS

Published in: Annals of Surgical Oncology | Issue 4/2013

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Abstract

Background

The circumferential resection margin (CRM) is highly prognostic for local recurrence in rectal cancer surgery without neoadjuvant treatment. However, its significance in the setting of long-course neoadjuvant chemoradiotherapy (nCRT) is not well defined.

Methods

Review of a single institution’s prospectively maintained database from 1998 to 2007 identified 563 patients with locally advanced rectal cancer (T3/T4 and/or N1) receiving nCRT, followed after 6 weeks by total mesorectal excision (TME). Kaplan-Meier, Cox regression, and competing risk analysis were performed.

Results

The authors noted that 75 % of all patients had stage III disease as determined by endorectal ultrasound (ERUS) and/or magnetic resonance imaging (MRI). With median follow-up of 39 months after resection, local and distant relapse were noted in 12 (2.1 %) and 98 (17.4 %) patients, respectively. On competing risk analysis, the optimal cutoff point of CRM was 1 mm for local recurrence and 2 mm for distant metastasis. Factors independently associated with local recurrence included CRM ≤1 mm, and high-grade tumor (p = 0.012 and 0.007, respectively). CRM ≤2 mm, as well as pathological, nodal, and overall tumor stage are also significant independent risk factors for distant metastasis (p = 0.025, 0.010, and <0.001, respectively).

Conclusion

In this dataset of locally advanced rectal cancer treated with nCRT followed by TME, CRM ≤1 mm is an independent risk factor for local recurrence and is considered a positive margin. CRM ≤2 mm was associated with distant recurrence, independent of pathological tumor and nodal stage.
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Metadata
Title
What is the Significance of the Circumferential Margin in Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiotherapy?
Authors
Atthaphorn Trakarnsanga, MD
Mithat Gonen, PhD
Jinru Shia, MD
Karyn A. Goodman, MD
Garrett M. Nash, MD
Larissa K. Temple, MD
José G. Guillem, MD
Philip B. Paty, MD
Julio Garcia-Aguilar, MD
Martin R. Weiser, MD, FACS
Publication date
01-04-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 4/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2722-7

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