title: Circumferential margin plays an independent impact on the outcome of rectal cancer patients receiving curative total mesorectal excision.
abstract: BACKGROUND
  The aim of this study was to determine the impact of the circumferential resection margin on the outcomes of patients with rectal cancer undergoing total mesorectal excision.
  
  
  METHODS
  Medical records from July 2004 to June 2008 were prospectively reviewed, and 348 patients who underwent potentially curative surgery for rectal cancer were identified. The influence of the circumferential resection margin on local recurrence, distant metastasis, and 5-year cancer-specific survival was assessed.
  
  
  RESULTS
  Of 348 patients, 13 (3.7%) had positive circumferential resection margins. During a median follow-up period of 58.0 months, 8 patients (2.3%) had local recurrence and 53 (15.2%) developed distant metastases. Local recurrence rates and distant metastasis rates in patients with positive circumferential resection margins were 15.4% and 61.5%, respectively, significantly higher than in those with negative circumferential resection margins (1.8% and 13.4%, respectively) (P < .001). The 5-year cancer-specific survival rates were 75.8% and 0% for patients with tumors having negative and positive circumferential resection margins, respectively (P < .001).
  
  
  CONCLUSIONS
  A circumferential resection margin of ≤1 mm adversely affects cancer-specific survival, local recurrence, and distant metastasis.
authors.affiliation: Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hung-Hsin
authors.initials: HH
authors.lastname: Lin
authors.forename: Jen-Kou
authors.initials: JK
authors.lastname: Lin
authors.forename: Chun-Chi
authors.initials: CC
authors.lastname: Lin
authors.forename: Yuan-Tzu
authors.initials: YT
authors.lastname: Lan
authors.forename: Huann-Sheng
authors.initials: HS
authors.lastname: Wang
authors.forename: Shung-Haur
authors.initials: SH
authors.lastname: Yang
authors.forename: Jeng-Kai
authors.initials: JK
authors.lastname: Jiang
authors.forename: Wei-Shone
authors.initials: WS
authors.lastname: Chen
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Lin
authors.forename: Wen-Yih
authors.initials: WY
authors.lastname: Liang
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D004730:Endothelium, Vascular / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*
keywords: Circumferential resection margin; Distant metastasis; Local recurrence; Rectal cancer; Total mesorectal excision