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Adequacy of 1-cm Distal Margin After Restorative Rectal Cancer Resection With Sharp Mesorectal Excision and Preoperative Combined-Modality Therapy

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Abstract

Background: Preoperative combined-modality therapy (CMT) for rectal cancer allows a sphincter-sparing procedure in some individuals who would otherwise require an abdominoperineal resection. To further define the subset of rectal cancer patients suitable for this approach, we determined the adequacy of a distal margin of ≤1 cm in patients with locally advanced rectal cancer requiring preoperative CMT.

Methods: Ninety-four consecutive patients, status post curative low anterior resection for rectal cancer after preoperative CMT, were identified from the prospective Colorectal Service Database. Distal margin length, tumor grade, tumor-node-metastasis stage, presence of lymphovascular and perineural invasion, and tumor distance from the anal verge were examined for their effect on recurrence and survival. Median follow-up was 44 months.

Results: Distal margin length ranged from .1 to 9.5 cm (median, 2.0 cm) and did not correlate with local recurrence (hazard ratio, 1.1; P = .34) or recurrence-free survival (hazard ratio, 1.1; P = .29) by univariate analysis. Kaplan-Meier estimates of recurrence-free survival and local recurrence at 3 years for the ≤1 cm versus >1 cm and the ≤2 cm versus >2 cm groups were not significantly different. Groups were well matched for other clinicopathologic variables.

Conclusions: Our data suggest that for patients with locally advanced rectal cancer undergoing resection and preoperative CMT, distal margins ≤1 cm do not seem to compromise oncological outcome.

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REFERENCES

  1. Ruo L, Guillem JG, Tickoo S, et al. Long-term prognostic significance of extent of rectal cancer response to preoperative radiation and chemotherapy. Ann Surg 2002; 236: 75–81.

    Article  PubMed  Google Scholar 

  2. Grann A, Feng C, Wong D, et al. Preoperative combined modality therapy for clinically resectable uT3 rectal adenocarcinoma. Int J Radiat Oncol Biol Phys 2001; 49: 987–95.

    Google Scholar 

  3. Andreola S, Leo E, Belli F, et al. Distal intramural spread in adenocarcinoma of the lower third of the rectum treated with total rectal resection and coloanal anastomosis. Dis Colon Rectum 1997; 40: 25–9.

    Google Scholar 

  4. Kwok SP, Lau WY, Leung KL, Liew CT, Li AK. Prospective analysis of the distal margin of clearance in anterior resection for rectal carcinoma. Br J Surg 1996; 83: 969–72.

    Google Scholar 

  5. 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.

    CAS  PubMed  Google Scholar 

  6. Kameda K, Furusawa M, Mori M, Sugimachi K. Proposed distal margin for resection of rectal cancer. Jpn J Cancer Res 1990; 81: 100–4.

    Google Scholar 

  7. 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.

    Google Scholar 

  8. Andreola S, Leo E, Belli F, et al. Adenocarcinoma of the lower third of the rectum surgically treated with a <10-mm distal clearance: preliminary results in 35 N0 patients. Ann Surg Oncol 2001; 8: 611–5.

    Google Scholar 

  9. Bozzetti F, Mariani L, Miceli R, Montalto F, Baratti D, Andreola S. Impact of distal clearance margin on oncologic outcome after restorative resection of the rectum. Tumori 1997; 83: 907–11.

    Google Scholar 

  10. Paty PB, Enker WE, Cohen AM, Lauwers GY. Treatment of rectal cancer by low anterior resection with coloanal anastomosis. Ann Surg 1994; 219: 365–73.

    Google Scholar 

  11. Vernava AM III, Moran M, Rothenberger DA, Wong WD. A prospective evaluation of distal margins in carcinoma of the rectum. Surg Gynecol Obstet 1992; 175: 333–6.

    Google Scholar 

  12. Karanjia ND, Schache DJ, North WR, Heald RJ.‘Close shave’ in anterior resection. Br J Surg 1990; 77: 510–2.

    Google Scholar 

  13. Hojo K. Anastomotic recurrence after sphincter-saving resection for rectal cancer. Length of distal clearance of the bowel. Dis Colon Rectum 1986; 29: 11–4.

    Google Scholar 

  14. Pollett WG, Nicholls RJ. The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg 1983; 198: 159–63.

    CAS  PubMed  Google Scholar 

  15. Kuvshinoff B, Maghfoor I, Miedema B, et al. Distal margin requirements after preoperative chemoradiotherapy for distal rectal carcinomas: are≤1 cm distal margins sufficient? Ann Surg Oncol 2001; 8: 163–9.

    Google Scholar 

  16. Grann A, Minsky BD, Cohen AM, et al. Preliminary results of preoperative 5-fluorouracil, low-dose leucovorin, and concurrent radiation therapy for clinically resectable T3 rectal cancer. Dis Colon Rectum 1997; 40: 515–22.

    CAS  PubMed  Google Scholar 

  17. Minsky BD, Oreilly E, Wong D. Daily low-dose irinotecan (CPT-11) plus pelvic irradiation as preoperative treatment of locally advanced rectal cancer (abstract). Proc Am Soc Clin Oncol 1999; 18: 266a.

    Google Scholar 

  18. Guillem JG, Cohen AM. Treatment options for mid- and low-rectal cancers. Adv Surg 2000; 34: 43–66.

    Google Scholar 

  19. LH Sobin, C Wittekind. Colon and rectum. In: Sobin LH, Wittekind C eds. TNM Classification of Malignant Tumours. 5th ed. New York: Wiley, 1997: 66.

  20. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–81.

    Google Scholar 

  21. Cox D, Oakes D. Analysis of survival data. New York: Chapman & Hall, 1990.

  22. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 1966; 50: 163–70.

    CAS  PubMed  Google Scholar 

  23. 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: 335–46.

    CAS  PubMed  Google Scholar 

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

    Google Scholar 

  25. Adam IJ, Mohamdee MO, Martin IG, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 1994; 344: 707–11.

    Article  CAS  PubMed  Google Scholar 

  26. Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 1998; 133: 894–9.

    Article  CAS  PubMed  Google Scholar 

  27. Ahmad NR, Nagle D. Long-term results of preoperative radiation therapy alone for stage T3 and T4 rectal cancer. Br J Surg 1997; 84: 1445–8.

    Google Scholar 

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Authors and Affiliations

  1. Departments of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

    Harvey G. Moore MD, Philip Paty MD, Douglas Wong MD, Alfred M. Cohen MD & Jose G. Guillem MD, MPH

  2. Departments of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York

    Elyn Riedel MA

  3. Departments of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York

    Bruce D. Minsky MD

  4. Departments of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York

    Leonard Saltz MD

  5. 1275 York Ave., Room C-1077, New York, NY 10021

    Jose G. Guillem MD, MPH

Authors
  1. Harvey G. Moore MD
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  2. Elyn Riedel MA
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  3. Bruce D. Minsky MD
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  4. Leonard Saltz MD
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  5. Philip Paty MD
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  6. Douglas Wong MD
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  7. Alfred M. Cohen MD
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  8. Jose G. Guillem MD, MPH
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Correspondence to Jose G. Guillem MD, MPH.

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Moore, H.G., Riedel, E., Minsky, B.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 10, 80–85 (2003). https://doi.org/10.1245/ASO.2003.04.010

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  • DOI: https://doi.org/10.1245/ASO.2003.04.010

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