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A Distal Resection Margin of ≤1 mm and Rectal Cancer Recurrence After Sphincter-Preserving Surgery: The Role of a Positive Distal Margin in Rectal Cancer Surgery

Zeng, Wei-gen M.D.1; Liu, Meng-jia M.M.2; Zhou, Zhi-xiang M.D.3; Wang, Zhen-jun M.D.1

doi: 10.1097/DCR.0000000000000900
Original Contributions: Colorectal Cancer
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BACKGROUND: There is little information about the prognostic value of a microscopically positive distal margin in patients who have rectal cancer.

OBJECTIVE: We aimed to investigate the influence of a distal margin of ≤1 mm on oncologic outcomes after sphincter-preserving resection for rectal cancer.

DESIGN: This is a retrospective cohort study.

SETTINGS: The study was conducted at 2 hospitals.

PATIENTS: A total of 6574 patients underwent anterior resection for rectal cancer from January 1999 to December 2014; 97 (1.5%) patients with a distal margin of ≤1 mm were included in this study. For comparative analyses, patients were matched with 194 patients with a negative distal margin (>1 mm) according to sex, age, BMI, ASA score, neoadjuvant treatment, tumor location, and stage.

MAIN OUTCOME MEASURES: The oncologic outcomes of the 2 groups were compared.

RESULTS: Perineural and lymphovascular invasion rates were significantly higher in patients with a positive distal margin (54.6% vs 28.9%; 67.0% vs 42.8%; both p < 0.001) compared with to patients with negative distal margin. Comparison between microscopically positive and negative distal margin showed worse oncologic outcomes in patients with a microscopically positive distal margin, including 5-year local recurrence rate (24.1% vs 12.0%, p = 0.005); 5-year distant recurrence rate (35.5% vs 20.2%, p = 0.011); 5-year disease-free survival (45.5% vs 69.5%, p < 0.001); and 5-year OS (69.2% vs 79.7%, p = 0.004). Among the 97 patients with a microscopically positive distal margin, the 5-year disease-free survival rate was higher in patients who received adjuvant therapy (52.0% vs 30.7%, p = 0.089).

LIMITATIONS: This is a retrospective study; bias may exist.

CONCLUSIONS: A distal margin of 1 mm is associated with worse oncologic results. Our data indicate the importance of achieving a clear distal margin in the surgical treatment of rectal cancer. Adjuvant therapy should be used in these patients to reduce recurrence. See Video Abstract at http://links.lww.com/DCR/A408.

1 Department of General Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China

2 Department of Ultrasound, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

3 Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

Funding/Support: None reported.

Financial Disclosures: None reported.

Zhi-xiang Zhou, M.D., and Zhen-jun Wang, M.D., contributed equally to this work.

Correspondence: Zhen-jun Wang, M.D., Department of General Surgery, Beijing Chao-yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing 100020, People’s Republic of China. E-mail: wzj_cyyy@163.com; Zhi-xiang Zhou, M.D., Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, People’s Republic of China. E-mail: zhzhxpumc@163.com.

© 2017 The American Society of Colon and Rectal Surgeons