Association between a close distal resection margin and recurrence after a sphincter-saving resection for t3 mid- or low-rectal cancer without radiotherapy.
OBJECTIVE
To maintain the patient's quality of life, surgeons strive to preserve the sphincter during rectal cancer surgery. This study evaluated the oncologic safety of a sphincter-saving resection with a distal resection margin (DRM) <1 cm without radiotherapy in T3, mid- or low-rectal cancer.


METHODS
This retrospective study enrolled 327 patients who underwent a sphincter-saving resection for proven T3 rectal cancer located <10 cm from the anal verge and without radiotherapy between January 1995 and December 2011. The oncologic outcomes included the 5-year cancer-specific survival, the local recurrence, and the systemic recurrence rates.


RESULTS
In groups A (DRM ≤1 cm) and B (DRM >1 cm), the 5-year cancer-specific survival rates were 81.57% and 80.03% (P = 0.8543), the 5-year local recurrence rates were 6.69% and 9.52% (P = 0.3981), and the 5-year systemic recurrence rates were 19.46% and 23.11% (P = 0.5750), respectively.


CONCLUSIONS
This study showed that the close DRM itself should not be a contraindication for a sphincter-saving resection for T3 mid- or low-rectal cancer without radiotherapy. However, a prospective randomized controlled trial including the effect of adjuvant therapy will be needed.
Department of Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Jae Woong
JW
Han
Department of Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Min Jae
MJ
Lee
Department of Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Ha Kyung
HK
Park
Department of Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Jae Ho
JH
Shin
Department of Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Min Sung
MS
An
Department of Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Tae Kwun
TK
Ha
Department of Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Kwang Hee
KH
Kim
Department of Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Ki Beom
KB
Bae
Department of Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Tae Hyun
TH
Kim
Department of Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Chang Soo
CS
Choi
Department of Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Sang Hoon
SH
Oh
Clinical Trial Center in Pharmacology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Min Kyung
MK
Oh
Department of Pathology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Mi Seon
MS
Kang
Department of Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Kwan Hee
KH
Hong
Distal resection margin; Rectal neoplasms; Recurrence