Quality of surgery in T3-4 rectal cancer: involvement of circumferential resection margin not influenced by preoperative treatment. Results from EORTC trial 22921.
OBJECTIVE
The present analyses aimed to determine risk factors for rectal cancer patients associated with circumferential resection margin (CRM) and number of examined lymph nodes (LN) and to correlate these parameters of surgical quality with local recurrence (LR), disease-free and overall survival (DFS and OS).


METHODS
Data of 884 eligible patients, who underwent a resection and had no metastases at time of surgery, were analysed.


RESULTS
Age, period of treatment, distance and pT-stage were associated with surgical quality. CRM involvement, but not the number of examined LN, was associated with a higher risk of an LR, reduced DFS and OS. An abdomino-perineal resection (APR) was a risk factor for adverse outcome.


CONCLUSIONS
Surgical quality is an important predictor of outcome, also for patients treated with conventional RT or chemoradiotherapy (CRT). Preoperative CRT results in downstaging and downsizing of the tumour, but not in less CRM involvement.
den Dulk
Marcel
M
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Collette
Laurence
L
van de Velde
Cornelis J H
CJ
Marijnen
Corrie A M
CA
Calais
Gilles
G
Mineur
Laurent
L
Maingon
Phillippe
P
Radosevic-Jelic
Ljiljana
L
Daban
Alain
A
Bosset
Jean-Francois
JF
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011787:Quality of Health Care; D012004:Rectal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D012044:Regression Analysis; D016896:Treatment Outcome