Impact of specific modes of circumferential resection margin involvement in rectal cancer local recurrence: A retrospective study

Purpose To compare the local recurrence rate and overall survival between patients with circumferential resection margin (CRM) involvement by direct tumor spread and by a tumor within a lymph node. Methods A total of 776 patients diagnosed with rectal cancer underwent rectal resection. Patients with...

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Bibliographic Details
Published in:Journal of surgical oncology 2018-12, Vol.118 (7), p.1122-1128
Main Authors: Suárez, Javier, Goicoetxea, Andrea, Gómez, M.L., Jiménez, G., Llanos, M.C., Jiménez, J., Montes, B., Miguel, M.
Format: Article
Language:English
Subjects:
Aged, 80 and over
Biopsy
Cancer surgery
Carcinoembryonic Antigen - metabolism
Chemotherapy, Adjuvant
circumferential resection margin (CRM)
Colorectal cancer
Female
Humans
local recurrence
Lymphatic Metastasis
Lymphatic system
Male
Margins of Excision
Neoadjuvant Therapy
Neoplasm Recurrence, Local - pathology
Patients
Radiotherapy, Adjuvant
rectal cancer
Rectal Neoplasms - mortality
Rectal Neoplasms - pathology
Rectal Neoplasms - therapy
Retrospective Studies
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Summary:Purpose To compare the local recurrence rate and overall survival between patients with circumferential resection margin (CRM) involvement by direct tumor spread and by a tumor within a lymph node. Methods A total of 776 patients diagnosed with rectal cancer underwent rectal resection. Patients with CRM involvement by direct tumor spread were named group A. CRM involvement by tumor within a lymph node formed group B. Patient data, including sex, age, pT, pN, stage I‐III versus IV, neoadjuvant radiotherapy, adjuvant chemotherapy, carcinoembryonic antigen, primary tumor location, lymph node retrieval, and need for abdominoperineal resection, were compared between both groups. Results In total, 10.5% of the patients had CRM involvement. Of these, in 57 cases (7.3%), it was by direct tumor spread and in 19 cases (2.4%) by tumor within a lymph node. Other types of CRM involvement were found in six patients. With a mean follow‐up of 32.9 months, 18 patients from group A (31.5%) and one patient from group B (5.2%) suffered a local recurrence. Local recurrence‐free survival was significantly higher in patients from group B (P = 0.049). Patients in stage I‐III (P = 0.037) and from group B ( P = 0.049) had better overall survival. Conclusion Patients with CRM involvement by tumor within a lymph node have a low risk of local recurrence and better overall survival than patients with CRM involvement by direct tumor spread.
ISSN:0022-4790
1096-9098
DOI:10.1002/jso.25252