title: Effects of positive resection margin and tumor distance from anus on rectal cancer treatment outcomes.
abstract: OBJECTIVE
  Rectal cancer outcome depends on stage, technical aspects of surgical excision, and use of adjuvant chemoradiation. Here, we examine effects of positive resection margin and tumor distance from the anus in stage 2 and 3 cancers on 4-year disease-specific survival and recurrence.
  
  
  METHODS
  We reviewed all 495 rectal cancer patients registered in British Columbia in 1996.
  
  
  RESULTS
  There were 481 cases analyzed: 29 in situ, 134 stage 1, 107 stage 2, 100 stage 3, 83 stage 4, and 28 unknown stage. Survival was significantly affected by presence of positive resection margin in stage 2 and 3 cancers, P = 0.0001. Lower tumor distance from the anus for stage 2 and 3 cancers worsened survival, P = 0.0007, and overall recurrence, P =0.016, but not local recurrence, P = 0.11. Adjuvant postoperative combined radiation and chemotherapy in stage 2 and 3 cancers significantly improved survival, P = 0.070 and local recurrence, P = 0.018, but not overall recurrence, P = 0.19.
  
  
  CONCLUSIONS
  Presence of positive resection margin and tumor distance from the anus affect survival, local recurrence, and overall recurrence. Adjuvant postoperative combined radiation and chemotherapy improved our outcomes. Our local recurrence rates for rectal cancers are worse than currently reported standards of less than 10%. Improved surgical excision and use of adjuvant preoperative radiation and chemotherapy may improve outcome.
authors.affiliation: British Columbia Cancer Agency, Department of Surgery, University of British Columbia, St. Paul's Hospital, 1081 Burrard St., Vancouver, British Columbia, Canada V6Z 1Y6. tphang@providencehealth.bc.ca
authors.forename: P Terry
authors.initials: PT
authors.lastname: Phang
authors.forename: John K
authors.initials: JK
authors.lastname: MacFarlane
authors.forename: Robert H
authors.initials: RH
authors.lastname: Taylor
authors.forename: Rona E
authors.initials: RE
authors.lastname: Cheifetz
authors.forename: Noelle
authors.initials: N
authors.lastname: Davis
authors.forename: John H
authors.initials: JH
authors.lastname: Hay
authors.forename: Greg
authors.initials: G
authors.lastname: McGregor
authors.forename: Caroline
authors.initials: C
authors.lastname: Speers
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Sullivan
authors.forename: Janet
authors.initials: J
authors.lastname: Pitts
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Coldman
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D006801:Humans; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D012189:Retrospective Studies; D012811:Sigmoid Neoplasms / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome