Factors Influencing Circumferential Resection Margin in Rectal Cancer.
Summary of "Factors Influencing Circumferential Resection Margin in Rectal Cancer."
Aim:  Abdominoperineal resection (APR) has been associated with higher circumferential resection margin (CRM) involvement and local recurrence rates than extralevator APR for low rectal cancer. This study aimed to evaluate CRM in APR and low anterior resection (LAR) specimens and to identify factors influencing CRM involvement. Method:  All pathological specimens from consecutive patients with rectal cancer who underwent curative resection at Cleveland Clinic Florida from 01/2000 to 07/2010 were reviewed by two pathologists. Demographics, tumour characteristics, operative data, postoperative pathology, and Dworak's tumour regression grade were compared between specimens with positive and negative CRM. Results:  154 patients underwent curative APR (n=65) or LAR (n=69). Mean tumour size was 3.6 cm, and mean distance from the dentate line was 5.4 cm. Nine (6.8%) patients had a positive CRM (n=6 APR, 3=LAR), which was associated with tumour size > 5.9 cm (p = 0.002), ≤ 2.6 cm distance from the dentate line (p = 0.013), microvascular invasion (p = 0.009), perineural invasion (p < 0.001), number of positive lymph nodes (p = 0.046), and incomplete total mesorectal excision (TME) (p < 0.001). APR specimens were three times more likely than LAR specimens to have an incomplete mesorectum (9.8%vs 2.9%, p = 0.322). Conclusions:  Factors associated with positive CRM were tumour size > 5.9 cm, < 2.6 cm distance from the dentate line, incomplete TME, number of positive nodes, and microvascular and perineural invasion. The incidence of a positive CRM did not significantly differ between LAR and APR (3 LAR, 6 APR). © 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.
Affiliation
Cleveland Clinic Florida, Weston, USA James Cook University, Townsville, Queensland, Australia.
Journal Details
This article was published in the following journal.
Name: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
ISSN: 1463-1318
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22776435
- DOI: http://dx.doi.org/10.1111/j.1463-1318.2012.03179.x
Medical and Biotech [MESH] Definitions
Confounding Factors (epidemiology)
Factors that can cause or prevent the outcome of interest, are not intermediate variables, and are not associated with the factor(s) under investigation. They give rise to situations in which the effects of two processes are not separated, or the contribution of causal factors cannot be separated, or the measure of the effect of exposure or risk is distorted because of its association with other factors influencing the outcome of the study.
Rectal Neoplasms
Tumors or cancer of the RECTUM.
Seer Program
A cancer registry mandated under the National Cancer Act of 1971 to operate and maintain a population-based cancer reporting system, reporting periodically estimates of cancer incidence and mortality in the United States. The Surveillance, Epidemiology, and End Results (SEER) Program is a continuing project of the National Cancer Institute of the National Institutes of Health. Among its goals, in addition to assembling and reporting cancer statistics, are the monitoring of annual cancer incident trends and the promoting of studies designed to identify factors amenable to cancer control interventions. (From National Cancer Institute, NIH Publication No. 91-3074, October 1990)
Colorectal Neoplasms
Tumors or cancer of the COLON or the RECTUM or both. Risk factors for colorectal cancer include chronic ULCERATIVE COLITIS; FAMILIAL POLYPOSIS COLI; exposure to ASBESTOS; and irradiation of the CERVIX UTERI.
Dental Scaling
Removal of dental plaque and dental calculus from the surface of a tooth, from the surface of a tooth apical to the gingival margin accumulated in periodontal pockets, or from the surface coronal to the gingival margin.
PubMed Articles
BACKGROUND: The circumferential resection margin (CRM) is highly prognostic for local recurrence in rectal cancer surgery without neoadjuvant treatment. However, its significance in the setting of lon...
BACKGROUND: Close circumferential resection margin (CRM) is an established predictor for locoregional recurrence (LR) in rectal cancer but remains controversial in esophageal malignancy. As yet, littl...
Short-term outcome of extra-levator abdominoperineal excision for rectal cancer.
BACKGROUND: Extra-levator abdominoperineal excision (ELAPE) has been introduced to avoid oncologic problems encountered with conventional abdominoperineal excision (APE) such as high rates of inadvert...
Length of lymphangiogenesis in the rectal tissues distal to rectal cancer.
To investigate the length of lymphangiogenesis in the rectal tissue distal to a rectal cancer and its effect on the resection margins of the rectum, 63 specimens of normal rectal tissue distal to the...
Clinical Trials
Randomized Prospective Trial for Laparoscopic vs Open Resection for Rectal Cancer
The investigators designed the randomized prospective trial of comparing open and laparoscopic resection in locally advanced rectal cancer after preoperative chemoradiation in order to det...
Randomized Trial on Robotic Assisted Resection for Rectal Cancer
Hypothesis: the bladder and sexual functions can be better preserved in patients with robotic assisted rectal surgery This is a randomized trial comparing the bladder and sexual function...
RATIONALE: Laparoscopic-assisted resection is a less invasive type of surgery for rectal cancer and may have fewer side effects and improve recovery. It is not yet known whether laparoscop...
Trial of Celecoxib With Preoperative Chemo- Radiation for Locally Advanced Rectal Cancer
This is a single arm phase II trial with combined celecoxib, tegafur-uracil, folinate and preoperative radiotherapy for patients with locally advanced rectal cancer. The primary end point...
Preoperative Chemoradiotheray for Rectal Cancer
Hypothesis - Pre operative radio-chemotherapy might be not mandatory to improve local recurrent rate and survival rate in the mid-lower rectal cancer patients with T3N0 clinical s...
