Effect of Circumferential Resection Margin (CRM) on Local Recurrence and Distant Metastases in Patients Treated With Neoadjuvant Chemoradiation for Rectal Cancer: Updated Analysis

2013 ◽  
Vol 87 (2) ◽  
pp. S342
Author(s):  
A.A. Alsuhaibani ◽  
T. Niazi ◽  
S. Vakilian ◽  
T. Vuong
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Distant Metastases ◽  
Neoadjuvant Chemoradiation

scholarly journals Multimodal Treatment of cT3 Rectal Cancer in a Prospective Multi-Center Observational Study: Can Neoadjuvant Chemoradiation Be Omitted in Patients with an MRI-Assessed, Negative Circumferential Resection Margin?

2021 ◽  
pp. 1-8
Author(s):  
Henry Ptok ◽  
Frank Meyer ◽  
Ingo Gastinger ◽  
Benjamin Garlipp
Keyword(s):  
Rectal Cancer ◽  
Observational Study ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Anal Verge ◽  
Final Analysis ◽  
Radical Resection ◽  
Distant Recurrence ◽  
Neoadjuvant Chemoradiation ◽  
Recurrence Rates

<b><i>Background/Aim:</i></b> Neoadjuvant chemoradiation (nCRT) in rectal cancer is associated with significant long-term morbidity. It is unclear whether nCRT in resectable mesorectal fascia circumferential resection margin (mrCRM)-negative rectal cancer treated by adequate total mesorectal excision (TME) is beneficial. The aim was to determine if nCRT can be omitted in patients with MRI-assessed cT3 rectal cancer and a negative mrCRM undergoing good-quality TME. <b><i>Methods:</i></b> By means of a prospective nationwide registry (<i>n</i> = 43.147; prospective multi-center observational study), patients with cT3 rectal cancer &#x3c;12 cm from the anal verge with a negative (&#x3e;1 mm) MRI-assessed CRM undergoing radical resection from 2006 to 2008 were selected. Overall, 87 patients were available for the final analysis (TME-alone, <i>n</i> = 25; nCRT+TME, <i>n</i> = 62). Groups were balanced for age, sex, and ASA score, with a nonsignificant predominance of males in the nCRT+TME group. As main outcome measures, local and distant recurrence rates were compared between patients undergoing primary surgery (TME-alone) vs. neoadjuvant chemoradiation + surgery (nCRT+TME). <b><i>Results:</i></b> In the TME-alone group, tumors were located closer to the anal verge (<i>p</i> = 0.018) and demonstrated a smaller minimal circumferential distance from the resection margin (<i>p</i> = 0.036). TME quality was comparable, as was median follow-up (48.9 vs. 44.9 months; <i>p</i> = 0.268). Local recurrences occurred at a similar rate in the TME-alone (<i>n</i> = 1; 5.3%) and nCRT+TME groups (<i>n</i> = 3; 5.5%) (<i>p</i> = 0.994) and were diagnosed at 10 months (TME-alone) and at 8, 13, and 18 months (nCRT+TME). Distant recurrences occurred in 28.9 and 17.4% of the cases, respectively (<i>p</i> = 0.626). The analysis was limited to cT3 cancers with a negative mrCRM. In addition, caution is required when appraising these results because of the limited number of evaluable subjects (especially in the TME-alone group), which adds some uncertainty to the statistical analysis. <b><i>Conclusions:</i></b> In this cohort of patients with rectal cancer located &#x3c;12 cm from the anal verge and a negative mrCRM undergoing adequate TME, omission of nCRT had no impact onto the local recurrence rate.

The Prognostic Value of Circumferential Resection Margin Involvement in Patients with Extraperitoneal Rectal Cancer

2016 ◽  
Vol 82 (4) ◽  
pp. 348-355 ◽  
Author(s):  
Dong Woo Shin ◽  
Jin Yong Shin ◽  
Sung Jin Oh ◽  
Jong Kwon Park ◽  
Hyeon Yu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Cox Model ◽  
Prognostic Significance ◽  
Multivariate Logistic Regression Analysis ◽  
T3 Rectal Cancer ◽  
Circumferential Resection Margin Involvement ◽  
Cox Analysis

The prognostic influence of circumferential resection margin (CRM) status in extraperitoneal rectal cancer probably differs from that of intraperitoneal rectal cancer because of its different anatomical and biological behaviors. However, previous reports have not provided the data focused on extraperitoneal rectal cancer. Therefore, the aim of this study was to examine the prognostic significance of the CRM status in patients with extraperitoneal rectal cancer. From January 2005 to December 2008, 248 patients were treated for extraperitoneal rectal cancer and enrolled in a pro-spectively collected database. Extraperitoneal rectal cancer was defined based on tumors located below the anterior peritoneal reflection, as determined intraoperatively by a surgeon. Cox model was used for multivariate analysis to examine risk factors of recurrence and mortality in the 248 patients, and multivariate logistic regression analysis was performed to identify predictors of recurrence and mortality in 135 patients with T3 rectal cancer. CRM involvement for extraperitoneal rectal cancer was present in 29 (11.7%) of the 248 patients, and was the identified predictor of local recurrence, overall recurrence, and death by multivariate Cox analysis. In the 135 patients with T3 cancer, CRM involvement was found to be associated with higher probability of local recurrence and mortality. In extraperitoneal rectal cancer, CRM involvement is an independent risk factor of recurrence and survival. Based on the results of the present study, it seems that CRM involvement in extraperitoneal rectal cancer is considered an indicator for (neo)adjuvant therapy rather than conventional TN status.

Pathology Studies of Combined Radical Resection of Seminal Vesicle in the Treatment of Rectal Cancer

2011 ◽  
Vol 96 (1) ◽  
pp. 51-55 ◽  
Author(s):  
Koji Komori ◽  
Takashi Hirai ◽  
Yukihide Kanemitsu ◽  
Yasuhiro Shimizu ◽  
Tsuyoshi Sano ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Seminal Vesicle ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Radical Resection ◽  
Seminal Vesicles ◽  
Recurrence Of Rectal Cancer

Abstract To inhibit local recurrence of rectal cancer, it is very important to ensure that there is a sufficient circumferential resection margin. We evaluated pathology studies of combined radical resection of seminal vesicles in the treatment of rectal cancer. We analyzed data from 7 cases of combined radical resection of the seminal vesicle in the treatment of rectal cancer; we also analyzed data from 35 control cases without seminal vesicle resection. The circumferential resection margin averaged 5.97 mm for cases that had combined radical resection of the seminal vesicle, and this was significantly longer than for cases without resection (P &lt; 0.001). Local recurrence was not seen in cases that had combined radical resection of the seminal vesicle, whereas 3 cases (5.9%) occurred in the group that did not undergo resection. Combined radical resection of the seminal vesicle in patients with rectal cancer ensures that the distance of the circumferential resection margin is sufficient to inhibit local recurrence.

Analysis of recurrence pattern and survival in locally advanced rectal cancer treated with neoadjuvant chemoradiation and surgery: 25 years of experience.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 744-744
Author(s):  
Javier A. Cienfuegos ◽  
Jorge Baixauli ◽  
Fernando Rotellar ◽  
Iosu Sola ◽  
Jorge Arredondo ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Neoadjuvant Chemoradiation ◽  
Pathological Response ◽  
Upper Third

744 Background: The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiation (CRT) followed by total mesorectal excision (TME). Despite the significant reduction (~ 40%) in local recurrence, the overall survival (OS) and disease free survival (DFS) remain stable during last decade. We aimed to study the pattern of recurrence and it’s relationship with clinico-pathological data in 356 patients with LARC treated with CRT and TME in last 25 years. Methods: From a total of 621 patients, 356 with LARC were analyzed. In 55 (15.4%) the tumor was localized in upper third, in 120 (33.7%) in middle third and in 181 (50.8%) in distal third. The median dose of radiotherapy for the 3 groups was between 47.5 - 48.52 Gy. Chemotherapy was based on 5-FU or capecitabine combined with oxaliplatin. Type of surgery, pathological response grade, circumferential resection margin, lymphovascular invasion, colloid response, local recurrence incidence, distal relapse, OS and DFS were analyzed. Results: The median interval between the end of CRT and surgery was 40 days. 52 low anterior resection were carried-out in upper third (94.5%), 112 (93.3%) in middle third and 92 (50.8%) in distal third. Four patients from the middle third (3.3%) underwent abdominoperineal resection and 72 (39.8%) in the distal location. No differences were observed in number of lymphoid nodes, vascular perineural invasion, and pathological response grade. A pathological complete response was assessed in 5 patients (9.1%) in upper third, in 12 (10%) in middle third, as well in 32 (17.7%) in distal third. Median follow-up of 187 months. The 5-10 year DFS for the 3 groups was 75%, 76%, and 69%, and 75%, 71%, and 66% respectively. The local recurrence rate was 3.6%, 4.2%, and 6.1%. The distal recurrence was more frequent in the lung, 10.9%, 16.7%, 23.8%, with tendency to be significant (p<0.007) in distal third. Conclusions: In spite of the good local control with the association of preoperative CRT and TME in treatment of LARC, the development of distant metastases, especially in distal third, gives rise to new therapeutics schemes. Further research is warranted as to the benefits of adjuvant chemotherapy.

scholarly journals Oncologic superiority of extralevator abdominoperineal excision for low rectal cancer

2013 ◽  
Vol 21 (1) ◽  
pp. 11-13
Author(s):  
Dejan Lukic ◽  
Zoran Radovanovic ◽  
Tomislav Petrovic ◽  
Milan Breberina ◽  
Andrija Golubovic ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Abdominoperineal Excision ◽  
Low Rectal Cancer ◽  
Margin Involvement ◽  
Radio Therapy ◽  
Circumferential Resection Margin Involvement ◽  
Prone Jackknife Position

Background: Rectal cancer treatment has been dramatically improved during the last two decades in terms of a lower local recurrence rate and prolonged survival. This improvement was achieved mainly due to a better surgical technique (implementation of a total mesorectal excision-TME) and neoadjuvant chemo and radio therapy. A more radical approach to abdominoperineal excision, extralevator abdominoperineal excision technique in the prone Jackknife position, may improve the oncological outcome. The aim of this study is to show our early experience by using extralevator abdominoperineal excision. Methods: Extralevator abdominoperineal excision has been used routinely at Oncology Institute of Vojvodina since 2011. In the last 23 months, we had 11 operations. Clinical and pathological data were obtained from operative protocols, histopathological data and patients? medical history. Results: An audit of results showed reduced rate of intra-operative perforations and circumferential resection margin involvement. Late postoperative complications have occurred in two patients, sexual dysfunction in one and pelvic pain in the other. The follow up period is too short (min 2 months, max 23 months, median 8 months) for analysis of local recurrence. Conclusion: Extralevator abdominoperineal excision, with the emphasis on the perienal dissection and prone Jackknife position, may help achieve the goals of radical resections for low rectal cancer. This technique could be associated with less intra-operative perforations and circumferential resection margin involvement.

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