Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Surgery Today
Published in: Surgery Today 4/2020

01-04-2020 | Rectal Cancer | Original Article

The clinical significance of distal spread differs according to the primary tumor location in rectal cancer

Authors: Kaoru Abe, Yoshifumi Shimada, Hidehito Oyanagi, Ryoma Yagi, Masato Nakano, Hitoshi Kameyama, Hitoshi Nogami, Satoshi Maruyama, Yasumasa Takii, Toshifumi Wakai

Published in: Surgery Today | Issue 4/2020

Login to get access

Abstract

Purpose

Treatment strategies of rectal cancer differ between tumors located above (RS/Ra) and below (Rb) the peritoneal reflection. Based on the extent of distal spread (DS), the Japanese Society for Cancer of Colon and Rectum proposed an optimal distal margin in RS/Ra and Rb tumors. In this study, we investigated the clinical significance of DS between RS/Ra and Rb tumors.

Methods

We analyzed 287 stage I–III rectal cancer patients who underwent curative intent resection without preoperative therapy. DS and other pathological factors were evaluated using whole-mount sections. To investigate the clinical significance of DS in RS/Ra and Rb tumors, clinicopathological variables, including DS, were analyzed for the survival outcome according to the tumor group.

Results

DS was detected in 20 out of 185 (11%) patients with RS/Ra tumors and 8 out of 102 (8%) patients with Rb tumors. DS was not significantly associated with the overall survival (OS) or relapse-free survival (RFS) in RS/Ra tumors, but was an independent prognostic factor for the OS and RFS in Rb tumors (P = 0.002 and 0.007, respectively).

Conclusions

The clinical significance of DS differs between RS/Ra and Rb tumors. DS is associated with a worse survival in Rb tumors, but not in RS/Ra tumors.
Literature
1.
Sugihara K, Kusunoki M, Japanese Society for Cancer of the Colon and Rectum [JSCCR]. Japanese classification of colorectal carcinomam. 2nd ed. Tokyo: Kanehara; 2009.
2.
Watanabe T, Muro K, Ajioka Y, Hashiguchi Y, Ito Y, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol. 2018;23:1–34.CrossRef
3.
Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol. 2015;20:207–39.CrossRef
4.
Sauer I, Bacon HE. Influence of lateral spread of cancer of the rectum on radicability of operation and prognosis. Am J Surg. 1951;81:111–20.CrossRef
5.
Fujita S, Mizusawa J, Kanemitsu Y, Ito M, Kinugasa Y, Komori K, et al. Mesorectal excision with or without lateral lymph node dissection for clinical stage II/III lower rectal cancer (JCOG0212): a multicenter, randomized controlled, noninferiority trial. Ann Surg. 2017;266:201–7.CrossRef
6.
Ono C, Yoshinaga K, Enomoto M, Sugihara K. Discontinuous rectal cancer spread in the mesorectum and the optimal distal clearance margin in situ. Dis Colon Rectum. 2002;45:744–9.CrossRef
7.
Shimada Y, Takii Y, Maruyama S, Ohta T. Intramural and mesorectal distal spread detected by whole-mount sections in the determination of optimal distal resection margin in patients undergoing surgery for rectosigmoid or rectal cancer without preoperative therapy. Dis Colon Rectum. 2011;54:1510–20.CrossRef
8.
Shirouzu K, Isomoto H, Kakegawa T. Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery. Cancer. 1995;76:388–92.CrossRef
9.
Williams NS, Dixon MF, Johnston D. Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients’ survival. Br J Surg. 1983;70:150–4.CrossRef
10.
Vernava AM 3rd, Moran M, Rothenberger DA, Wong WD. A prospective evaluation of distal margins in carcinoma of the rectum. Surg Gynecol Obstet. 1992;175:333–6.PubMed
11.
Wilson SM, Beahrs OH. The curative treatment of carcinoma of the sigmoid, rectosigmoid, and rectum. Ann Surg. 1976;183:556–65.CrossRef
12.
Madsen PM, Christiansen J. Distal intramural spread of rectal carcinomas. Dis Colon Rectum. 1986;29:279–82.CrossRef
13.
Nakagoe T, Yamaguchi E, Tanaka K, Sawai T, Tsuji T, Shibasaki S, et al. Distal intramural spread is an independent prognostic factor for distant metastasis and poor outcome in patients with rectal cancer: a multivariate analysis. Ann Surg Oncol. 2003;10:163–70.CrossRef
14.
Park IJ, Kim JC. Adequate length of the distal resection margin in rectal cancer: from the oncological point of view. J Gastrointest Surg. 2010;14:1331–7.CrossRef
15.
Amin MB, Edge SB, Greene FL, Byrd DR, Brookland RK, Washington MK, et al., editors. AJCC cancer staging manual. 8th ed. New York: Springer; 2017.
16.
Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg. 1982;69:613–6.CrossRef
17.
Mezhir JJ, Shia J, Riedel E, Temple LK, Nash GM, Weiser MR, et al. Whole-mount pathologic analysis of rectal cancer following neoadjuvant therapy: implications of margin status on long-term oncologic outcome. Ann Surg. 2012;256:274–9.CrossRef
18.
Guillem JG, Chessin DB, Shia J, Suriawinata A, Riedel E, Moore HG, et al. A prospective pathologic analysis using whole-mount sections of rectal cancer following preoperative combined modality therapy: implications for sphincter preservation. Ann Surg. 2007;245:88–93.CrossRef
19.
Moore HG, Riedel E, Minsky BD, Saltz L, Paty P, Wong D, et al. Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapy. Ann Surg Oncol. 2003;10:80–5.CrossRef
20.
Rutkowski A, Bujko K, Nowacki MP, Chmielik E, Nasierowska-Guttmejer A, Wojnar A, et al. Distal bowel surgical margin shorter than 1 cm after preoperative radiation for rectal cancer: is it safe? Ann Surg Oncol. 2008;15:3124–31.CrossRef
21.
Watanabe T, Kazama S, Nagawa H. A 1 cm distal bowel margin is safe for rectal cancer after preoperative radiotherapy. Hepatogastroenterology. 2012;59:1068–74.PubMed
22.
Kondo A, Tsukada Y, Kojima M, Nishizawa Y, Sasaki T, Suzuki Y, et al. Effect of preoperative chemotherapy on distal spread of low rectal cancer located close to the anus. Int J Colorect Dis. 2018;33:1685–93.CrossRef
23.
Kinoshita O, Nakanishi M, Murayama Y, Kuriu Y, Kokuba Y, Otsuji E. Flattened tumor requires a more careful attention for residual distal cancer spread in locally advanced lower rectal carcinoma after chemoradiotherapy. Dig Surg. 2015;32:159–65.CrossRef
24.
Guedj N, Maggiori L, Poté N, Norkowski E, Cros J, Bedossa P, et al. Distal intramural and tumor spread in the mesorectum after neoadjuvant radiochemotherapy in rectal cancer: about 124 consecutive patients. Hum Pathol. 2016;52:164–72.CrossRef
25.
Scott N, Jackson P, Al-Jaberi T, Dixon MF, Quirke P, Finan PJ. Total mesorectal excision and local recurrence: a study of tumour spread in the mesorectum distal to rectal cancer. Br J Surg. 1995;82:1031–3.CrossRef
26.
Reynolds JV, Joyce WP, Dolan J, Sheahan K, Hyland JM. Pathological evidence in support of total mesorectal excision in the management of rectal cancer. Br J Surg. 1996;83:1112–5.CrossRef
27.
Hida J, Yasutomi M, Maruyama T, Fujimoto K, Uchida T, Okuno K. Lymph node metastases detected in the mesorectum distal to carcinoma of the rectum by the clearing method: justification of total mesorectal excision. J Am Coll Surg. 1997;184:584–8.PubMed
28.
Zhao GP, Zhou ZG, Lei WZ, Yu YY, Wang C, Wang Z, et al. Pathological study of distal mesorectal cancer spread to determine a proper distal resection margin. World J Gastroenterol. 2005;11:319–22.CrossRef
Metadata
Title
The clinical significance of distal spread differs according to the primary tumor location in rectal cancer
Authors
Kaoru Abe
Yoshifumi Shimada
Hidehito Oyanagi
Ryoma Yagi
Masato Nakano
Hitoshi Kameyama
Hitoshi Nogami
Satoshi Maruyama
Yasumasa Takii
Toshifumi Wakai
Publication date
01-04-2020
Publisher
Springer Singapore
Published in
Surgery Today / Issue 4/2020
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-019-01882-x

Other articles of this Issue 4/2020

Surgery Today 4/2020 Go to the issue

Correction

Correction to: Recent progress in multidisciplinary treatment for patients with esophageal cancer

Review Article

The past, present, and future status of multimodality treatment for resectable/borderline resectable pancreatic ductal adenocarcinoma

Original Article

Endoscopic hepatic resection and endoscopic radiofrequency ablation as initial treatments for hepatocellular carcinoma within the Milan criteria

Original Article

Predictors of postoperative early recurrence of extrahepatic bile duct cancer

Correction

Correction to: Perioperative chemotherapy for locally advanced gastric cancer in Japan: current and future perspectives

Review Article

The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection