title: The Importance of a Minimal Tumor-Free Resection Margin in Locally Recurrent Rectal Cancer.
abstract: BACKGROUND
  The importance of the circumferential resection margin has been demonstrated in primary rectal cancer, but the role of the minimal tumor-free resection margin in locally recurrent rectal cancer is unknown.
  
  
  OBJECTIVE
  The purpose of this work was to evaluate the prognostic importance of a minimal tumor-free resection margin in locally recurrent rectal cancer.
  
  
  METHODS
  This was a single-institution, retrospective study.
  
  
  METHODS
  This study was conducted in a tertiary referral hospital.
  
  
  METHODS
  Based on the final pathology report, surgically treated patients with locally recurrent rectal cancer between 1990 and 2013 were divided into 4 groups: 1) tumor-free margins of >2 mm, 2) tumor-free margins of >0 to 2 mm, 3) microscopically involved margins, and 4) macroscopically involved margins.
  
  
  METHODS
  Local control and overall survival were the main outcome measures.
  
  
  RESULTS
  A total of 174 patients with a median follow-up of 27 months (range, 0-144 months) were eligible for analysis. There was a significant difference in 5-year local re-recurrence-free survival in favor of 41 patients with tumor-free margins of >2 mm compared with 34 patients with tumor-free margins of >0 to 2 mm (80% vs 62%; p = 0.03) and a significant difference in 5-year overall survival (60% vs 37%; p = 0.01). The 5-year local re-recurrence-free and overall survival rates for 55 patients with microscopically involved margins were 28% and 16%, and for 20 patients with macroscopically involved margins the rates were 0% and 5%. On multivariable analysis, tumor-free margins of >0 to 2 mm were independently associated with higher re-recurrence rates (HR, 2.76 (95% CI, 1.06-7.16)) and poorer overall survival (HR, 2.57 (95% CI, 1.27-5.21)) compared with tumor-free margins of >2 mm.
  
  
  CONCLUSIONS
  This study was limited by its retrospective nature.
  
  
  CONCLUSIONS
  Resection margin status is an independent prognostic factor for re-recurrence rate and overall survival in surgically treated, locally recurrent rectal cancer. In complete resections, patients with tumor-free resection margins of >0 to 2 mm have a higher re-recurrence rate and a poorer overall survival than patients with tumor-free resection margins of >2 mm.
authors.affiliation: 1 Division of Surgical Oncology, Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands 2 Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands 3 Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, the Netherlands 4 Division of Surgical Oncology, Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Wijnand J
authors.initials: WJ
authors.lastname: Alberda
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.forename: Marguerite E I
authors.initials: ME
authors.lastname: Schipper
authors.forename: Joost J
authors.initials: JJ
authors.lastname: Nuyttens
authors.forename: Joost
authors.initials: J
authors.lastname: Rothbarth
authors.forename: Johannes H W
authors.initials: JH
authors.lastname: de Wilt
authors.forename: Jabobus W A
authors.initials: JW
authors.lastname: Burger
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome