Impact of specific modes of circumferential resection margin involvement in rectal cancer local recurrence: A retrospective study

• Published in: Journal of surgical oncology 2018-12, Vol.118 (7), p.1122-1128
• Main Authors: Suárez, Javier, Goicoetxea, Andrea, Gómez, M.L., Jiménez, G., Llanos, M.C., Jiménez, J., Montes, B., Miguel, M.
• Format: Article
• Language: English
• Subjects: Biopsy; Cancer surgery; circumferential resection margin (CRM); Colorectal cancer; local recurrence; Lymphatic system; Patients; rectal cancer
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.25252

Purpose To compare the local recurrence rate and overall survival between patients with circumferential resection margin (CRM) involvement by direct tumor spread and by a tumor within a lymph node. Methods A total of 776 patients diagnosed with rectal cancer underwent rectal resection. Patients with CRM involvement by direct tumor spread were named group A. CRM involvement by tumor within a lymph node formed group B. Patient data, including sex, age, pT, pN, stage I‐III versus IV, neoadjuvant radiotherapy, adjuvant chemotherapy, carcinoembryonic antigen, primary tumor location, lymph node retrieval, and need for abdominoperineal resection, were compared between both groups. Results In total, 10.5% of the patients had CRM involvement. Of these, in 57 cases (7.3%), it was by direct tumor spread and in 19 cases (2.4%) by tumor within a lymph node. Other types of CRM involvement were found in six patients. With a mean follow‐up of 32.9 months, 18 patients from group A (31.5%) and one patient from group B (5.2%) suffered a local recurrence. Local recurrence‐free survival was significantly higher in patients from group B (P = 0.049). Patients in stage I‐III (P = 0.037) and from group B ( P = 0.049) had better overall survival. Conclusion Patients with CRM involvement by tumor within a lymph node have a low risk of local recurrence and better overall survival than patients with CRM involvement by direct tumor spread.