Impact of Distal Clearance Margin on Oncologic Outcome after Restorative Resection of the Rectum

There is considerable controversy about the distal clearance margin that needs to be maintained beyond the extent of a rectal tumor in order to reduce the risk of local recurrence. We investigated the rate of local recurrence, distant metastases and survival in 87 patients who had undergone radical restorative resection of the rectum for cancer and had been followed up for a median period of over 6 years, and we analyzed the statistical relation (log-rank test for trend) with the length of the distal margin. The distal margin length was divided into three categories: 1 cm, 2 cm, and ≥3 cm. No significant correlation was found between the length of the distal clearance margin and the oncologic outcome. Taken together, our data suggest that if the resection line distally falls on healthy tissue, there is no need to resect additional rectum in order to achieve a better outcome.

Distal Intramural Spread in Colorectal Cancer: A Reappraisal of the Extent of Distal Clearance in Fifty Cases

Fifty colorectal carcinomas were Investigated to demonstrate distal intramural spread (DIS). In 17 cases (34 %) a DIS ranging from 0.25 to 3.5 cm was present. DIS was positively correlated with stage C2 (p < 0.01), lymph node metastasis (p < 0.03) and Infiltrative growth of the tumor (p < 0.05). Our results show that DIS is a relatively frequent event but of limited extension. In fact, a distal clearance margin of 2 cm was considered safe for all patients but one C2 mucoid case. No pathologic feature can predict preoperatively the presence and extent of DIS.