title: Rectal cancers with microscopic circumferential resection margin involvement (R1 resections): Survivals, patterns of recurrence, and prognostic factors.
abstract: OBJECTIVE
  We have reviewed our series of rectal cancer patients with circumferential resection margin involvement (R1) with particular regard to survival and prognostic factors.
  
  
  METHODS
  R1 rectal cancer patients undergoing surgery at the Leicester Royal Infirmary between 1998 and 2008. Age, gender, radiological, and pathological tumor characteristics, neoadjuvant and adjuvant therapies were examined as prognostic factors on the overall survival (OS) and disease-free survival (DFS) at 5-year follow-up.
  
  
  RESULTS
  A total of 885 rectal cancers were reviewed. Six hundred ninety-nine patients underwent a mesorectal excision and 71 of them were R1 resections (12.9%). OS was 43.7% (CI95% 33.5-53.8%; median survival 39 months). DFS was 57.4% (CI95% 43.0-71.8%; median survival 31 months). Pelvic recurrence rate occurred in 16 patients (26.2%, CI95% 16.5-36.0%), systemic recurrence rate in 23 patients (37.7%, CI95% 25.5-49.9%). At Cox-regression LNR and adjuvant chemotherapy were associated with both OS and DFS. No significant association was found between OS or DFS and adjuvant radiotherapy.
  
  
  CONCLUSIONS
  In our series of R1 patients, the rates of local recurrence and OS at 5 years were 26.2% and 43.7%, respectively. Factors influencing systemic recurrences (LNR, adjuvant chemotherapy) are more associated with OS and DFS than those potentially affecting locoregional recurrences (adjuvant radiotherapy). J. Surg. Oncol. 2016;114:642-648. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom. ggravante@hotmail.com.
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Gravante
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Hemingway
authors.affiliation: Department of Radiology, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: James Andrew
authors.initials: JA
authors.lastname: Stephenson
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Sharpe
authors.affiliation: Department of Oncology, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Osman
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: Melissa
authors.initials: M
authors.lastname: Haines
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: Vafa
authors.initials: V
authors.lastname: Pirjamali
authors.affiliation: Laboratory of Biometry, Department of Human Physiology, University of Tor Vergata, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Sorge
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: Justin Ming
authors.initials: JM
authors.lastname: Yeung
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Norwood
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Miller
authors.affiliation: Department of Colorectal Surgery, Leicester Royal Infirmary, Leicester, United Kingdom.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Boyle
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: circumferential margins; colorectal cancer; prognostic factors; survival