The influence of circumferential resection margins on survival following rectal cancer surgery

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COD: 02_2017_09_2630 Categorie: ,

Emil Mois, Florin Graur, Nadim Al Hajjar, Cosmin Puia, Adrian Cot¸e, Florin Zaharie, Adrian Bartos, Noemi Al Momani, Flaviu Pop, Horatiu Neagos, George Ciorogar, Cornel Iancu

Ann Ital Chir, 2016 88, 2: 149-154
Epub Ahead of Print 20 Dec. 2016

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BACKGROUND AND AIMS: A negative (R0) circumferential resection margin (CRM) is described as one of the most important
factor that decrease the rate of local recurrence in rectal cancer. The primary outcome of the study was the status
of the CRM, while the secondary outcomes were local recurrence and overall survival.
METHODS: Study includes 192 patients with rectal cancer operated between January 2012 and December 2013 in our
Institute. The incidence of positive CRM and its impact on the survival rates after oncologic surgical resection were
investigated along with factors that determine positive CRM. R1 was defined as a distance of ≤ 1 mm between the
tumor and the resection margin.
RESULTS: The R1 rate was 3.6 % (7 cases). Nine patients (4.68%) developed local recurrence during a median followup
period of 720 days. A positive CRM was found to be a risk factor of local recurrence (p-value = 0.031) and it
decreased the overall survival (p-value=0.001). pT4 stage (p-value=0.008) and vascular invasion (p-value=0.005) are
factors that play significant roles in determining CRM positivity. In case of inferior rectal tumours abdomino-perineal
resection (APR) determines significantly higher (p-value=0.048) rates of positive CRM than anterior resection (AR) of
the rectum.
CONCLUSIONS: Positive CRM affects overall survival and local recurrence in rectal cancer. pT4 stage and vascular invasion
play determinant roles in determine CRM status. APR is a risk factor for positive CRM in inferior rectal tumors.