Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapy.
BACKGROUND
Preoperative combined-modality therapy (CMT) for rectal cancer allows a sphincter-sparing procedure in some individuals who would otherwise require an abdominoperineal resection. To further define the subset of rectal cancer patients suitable for this approach, we determined the adequacy of a distal margin of < or = 1 cm in patients with locally advanced rectal cancer requiring preoperative CMT.


METHODS
Ninety-four consecutive patients, status post curative low anterior resection for rectal cancer after preoperative CMT, were identified from the prospective Colorectal Service Database. Distal margin length, tumor grade, tumor-node-metastasis stage, presence of lymphovascular and perineural invasion, and tumor distance from the anal verge were examined for their effect on recurrence and survival. Median follow-up was 44 months.


RESULTS
Distal margin length ranged from.1 to 9.5 cm (median, 2.0 cm) and did not correlate with local recurrence (hazard ratio, 1.1; P =.34) or recurrence-free survival (hazard ratio, 1.1; P =.29) by univariate analysis. Kaplan-Meier estimates of recurrence-free survival and local recurrence at 3 years for the < or = 1 cm versus >1 cm and the < ore = 2 cm versus > 2 cm groups were not significantly different. Groups were well matched for other clinicopathologic variables.


CONCLUSIONS
Our data suggest that for patients with locally advanced rectal cancer undergoing resection and preoperative CMT, distal margins < or = 1 cm do not seem to compromise oncological outcome.
Moore
Harvey G
HG
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Riedel
Elyn
E
Minsky
Bruce D
BD
Saltz
Leonard
L
Paty
Philip
P
Wong
Douglas
D
Cohen
Alfred M
AM
Guillem
Jose G
JG
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*