title: Acceptance of a 5-mm distal bowel resection margin for rectal cancer: is it safe?
abstract: OBJECTIVE
  Acceptance of a short distal bowel margin results in a higher rate of anterior resection but may compromise oncological safety. This study aimed to evaluate the safety of a 5-mm distal margin.
  
  
  METHODS
  A retrospective analysis was carried out of 412 consecutive patients with rectal cancer treated with anterior resection with a negative circumferential resection margin. Radiotherapy was given to 63% of patients with an advanced tumour. The median follow up was 75 months.
  
  
  RESULTS
  Fewer patients in the group with a distal margin of ≤ 5 mm had a tumour with an advanced pT stage compared to patients in the group with a distal margin of > 5 mm (P = 0.033). Two patients were converted to abdominoperineal resection because of a positive 'doughnut', leaving 410 patients, in whom 5.4% (95% CI, 0-11.3%) of the group with a distal margin of ≤ 5 mm had local recurrence at 5 years compared with 4.2% (95% CI, 2.1-6.3%) of the group with a distal margin of > 5 mm (P = 0.726). The corresponding figures for the 5-year overall survival were 82.4% (95% CI, 72.6-92.2%) vs 76.3% (95% CI, 71.8-80.8%) (P = 0.581). All four anastomotic recurrences occurred in the group with a distal margin of > 5 mm.
  
  
  CONCLUSIONS
  A distal margin of ≤ 5 mm did not compromise oncological safety in patients undergoing preoperative radiation for an advanced rectal cancer.
authors.affiliation: Departments of Colorectal Cancer Radiotherapy, The Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland. az.rutkowski@onet.eu
authors.forename: A
authors.initials: A
authors.lastname: Rutkowski
authors.forename: M P
authors.initials: MP
authors.lastname: Nowacki
authors.forename: M
authors.initials: M
authors.lastname: Chwalinski
authors.forename: J
authors.initials: J
authors.lastname: Oledzki
authors.forename: M
authors.initials: M
authors.lastname: Bednarczyk
authors.forename: P
authors.initials: P
authors.lastname: Liszka-Dalecki
authors.forename: A
authors.initials: A
authors.lastname: Gornicki
authors.forename: K
authors.initials: K
authors.lastname: Bujko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome