title: Sparing Sphincters and Laparoscopic Resection Improve Survival by Optimizing the Circumferential Resection Margin in Rectal Cancer Patients.
abstract: The goal of rectal cancer treatment is to minimize the local recurrence rate and extend the disease-free survival period and survival. For this aim, obtainment of negative circumferential radial margin (CRM) plays an important role. This study evaluated predictive factors for positive CRM status and its effect on patient survival in mid- and distal rectal tumors.Patients who underwent curative resection for rectal cancer were included. The main factors were demographic data, tumor location, surgical technique, neoadjuvant therapy, tumor diameter, tumor depth, lymph node metastasis, mesorectal integrity, CRM, the rate of local recurrence, distant metastasis, and overall and disease-free survival. Statistical analyses were performed by using the Chi-squared test, Fisher exact test, Student t test, Mann-Whitney U test and the Mantel-Cox log-rank sum test.A total of 420 patients were included, 232 (55%) of whom were male. We observed no significant differences in patient characteristics or surgical treatment between the patients who had positive CRM and who had negative CRM, but a higher positive CRM rate was observed in patients undergone abdominoperineal resection (APR) (P < 0.001). Advanced T-stage (P < 0.001), lymph node invasion (P = 0.001) and incomplete mesorectum (P = 0.007) were encountered significantly more often in patients with positive CRM status. Logistic regression analysis revealed that APR (P < 0.001) and open resection (P = 0.046) were independent predictors of positive CRM status. Moreover, positive CRM was associated with decreased 5-year overall and disease-free survival (P = 0.002 and P = 0.004, respectively).This large single-institution series demonstrated that APR and open resection were independent predictive factors for positive CRM status in rectal cancer. Positive CRM independently decreased the 5-year overall and disease-free survival rates.
authors: From the Istanbul University, Istanbul Faculty of Medicine, General Surgery Department, Millet Caddesi, Capa, Istanbul, Turkey (MK, AB, ES, MTB); Istanbul University, Istanbul Faculty of Medicine, Pathology Department, Millet Caddesi, Capa, Istanbul, Turkey (GY); Fatih Sultan Mehmet Education and Research Hospital, Department of General Surgery, İçerenköy-Ataşehir, Istanbul, Turkey (BK); Istanbul University, Oncology Institute, Millet Caddesi, Capa, Istanbul, Turkey (ES); and Koc University, School of Medicine, General Surgery Department, Rumelifeneri Yolu, Sarıyer, Istanbul, Turkey (EB).
authors: Metin
authors: M
authors: Keskin
authors: Adem
authors: A
authors: Bayraktar
authors: Emre
authors: E
authors: Sivirikoz
authors: Gülcin
authors: G
authors: Yegen
authors: Bora
authors: B
authors: Karip
authors: Esra
authors: E
authors: Saglam
authors: Mehmet Türker
authors: MT
authors: Bulut
authors: Emre
authors: E
authors: Balik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D059351:Organ Sparing Treatments; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology; D012189:Retrospective Studies; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult