Acceptance of a 5-mm distal bowel resection margin for rectal cancer: is it safe?

• Published in: Colorectal disease 2012-01, Vol.14 (1), p.71-78
• Main Authors: Rutkowski, A., Nowacki, M. P., Chwalinski, M., Oledzki, J., Bednarczyk, M., Liszka-Dalecki, P., Gornicki, A., Bujko, K.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; anterior resection; Chemotherapy, Adjuvant; Chi-Square Distribution; Combined Modality Therapy; Digestive System Surgical Procedures - methods; distal bowel margin; Female; Humans; Male; Middle Aged; Neoplasm Staging; Postoperative Complications; Rectal cancer; Rectal Neoplasms - drug therapy; Rectal Neoplasms - pathology; Rectal Neoplasms - radiotherapy; Rectal Neoplasms - surgery; Retrospective Studies; Statistics, Nonparametric; Survival Rate; Treatment Outcome
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/j.1463-1318.2010.02542.x

Aim  Acceptance of a short distal bowel margin results in a higher rate of anterior resection but may compromise oncological safety. This study aimed to evaluate the safety of a 5‐mm distal margin. Method  A retrospective analysis was carried out of 412 consecutive patients with rectal cancer treated with anterior resection with a negative circumferential resection margin. Radiotherapy was given to 63% of patients with an advanced tumour. The median follow up was 75 months. Results  Fewer patients in the group with a distal margin of ≤ 5 mm had a tumour with an advanced pT stage compared to patients in the group with a distal margin of > 5 mm (P = 0.033). Two patients were converted to abdominoperineal resection because of a positive ‘doughnut’, leaving 410 patients, in whom 5.4% (95% CI, 0–11.3%) of the group with a distal margin of ≤ 5 mm had local recurrence at 5 years compared with 4.2% (95% CI, 2.1–6.3%) of the group with a distal margin of > 5 mm (P = 0.726). The corresponding figures for the 5‐year overall survival were 82.4% (95% CI, 72.6–92.2%) vs 76.3% (95% CI, 71.8–80.8%) (P = 0.581). All four anastomotic recurrences occurred in the group with a distal margin of > 5 mm. Conclusion  A distal margin of ≤ 5 mm did not compromise oncological safety in patients undergoing preoperative radiation for an advanced rectal cancer.