title: Close distal margin and rectal cancer recurrence after sphincter-preserving rectal resection.
abstract: OBJECTIVE
  Negative surgical margins are important for local control of rectal cancer treated with sphincter-preserving surgery. However, the association of rectal cancer recurrence with close distal margin is not well established.
  
  
  METHODS
  Data were extracted from a prospective database of patients collected between 1991 and 2003. Included were 627 patients who underwent curative low anterior resection with total mesorectal excision for rectal cancer 2 to 12 cm from the anal verge. Three hundred ninety-nine patients received neoadjuvant therapy, 65 received postoperative adjuvant therapy alone, and 163 were treated with surgery alone. Median follow-up was 5.8 years.
  
  
  RESULTS
  On multivariable analysis, overall recurrence was associated with pathologic stage, lymphovascular invasion, and distal margin. Mucosal recurrence was uncommon; only 16 events were recorded, and of those only 8 were at the initial site of isolated tumor recurrence; 7 of the 8 were surgically salvaged. On univariable analysis, mucosal recurrence was associated with close distal margin (5 vs 2% at 5 y) and lymphovascular invasion (7 vs 2%). Pelvic recurrence, other than isolated mucosal recurrence, was associated with distal location (6 vs 4% at 5 y) and lymphovascular invasion (11 vs 4%). Distal margin as a continuous variable was associated with overall recurrence (excluding isolated mucosal recurrence).
  
  
  CONCLUSIONS
  Close distal resection margin identifies patients with increased risk of mucosal and overall cancer recurrence. Although neither causality nor a minimally acceptable margin length can be defined, the data support the importance of achieving a clear distal resection margin in the surgical management of rectal cancer.
authors.affiliation: Department of Surgery, Colorectal Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. nashg@mskcc.org
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Nash
authors.forename: Alexander
authors.initials: A
authors.lastname: Weiss
authors.forename: Roshni
authors.initials: R
authors.lastname: Dasgupta
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: Jose G
authors.initials: JG
authors.lastname: Guillem
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Wong
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome