Prognostic Significance of Circumferential Resection Margin following a Total Mesorectal Excision in Rectal Cancer.
- Author:
Seung Hyuk BAIK
1
;
Nam Kyu KIM
;
Kang Young LEE
;
Seung Kook SOHN
;
Chang Hwan CHO
;
Ho guen KIM
;
Sun Young RHA
;
Hyun Cheol CHUNG
Author Information
1. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. namkyuk@yumc.yonsei.ac.kr
- Publication Type:Original Article
- Keywords:
Circumferential resection margin;
Total mesorectal excision;
Rectal cancer
- MeSH:
Chemoradiotherapy, Adjuvant;
Humans;
Multivariate Analysis;
Pathology;
Prognosis;
Rectal Neoplasms*;
Recurrence;
Survival Rate
- From:Journal of the Korean Society of Coloproctology
2005;21(5):307-313
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Studies of the circumferential resection margin (CRM) in rectal cancer surgery have revealed that inadequate surgical excision correlates with a high risk of recurrence. This study was designed to evaluate the prognostic value of the CRM in rectal cancer. METHODS: All 504 patients who underwent a total mesorectal excision for rectal cancer between 1997 and 2001 were studied. The distance between the CRM and the tumor on pathology slides (HE stain, x 20 times) was measured. The CRM was stained by using the Davidson marking system(R) (Bradley Product, Inc. USA), and a micrometer was used for the measurement. We divided the patients into a negative CRM group (CRM >3 mm), an abutting CRM group (CRM < or =3 mm without involvement), and a positive CRM group (CRM was in the tumor), and compared the oncologic results among the groups. RESULTS: The numbers of patients in the negative CRM, the abutting CRM, and the positive CRM groups were 452, 18, and 34 respectively. The mean follow- up durations were 45.1 months (range, 1.1~88.7), 41.9 months (range, 10.7~75.2), and 33.0 months (range, 4.8~83.4), respectively. The Aslter-Coller stages of all patients were from B2 to C3. The local recurrence rate, the systemic recurrence rate, and the combined recurrence rate were, respectively, 5.5%, 17.3%, and 3.8% in the negative CRM group (>3 mm), 5.6%, 38.9%, and 5.6% in the abutting CRM group, and 8.8%, 44.1%, and 8.8% in the positive CRM group. The five-year survival rates for the negative CRM, the abutted CRM and the positive CRM groups were 73.3%, 48.4%, and 25.5% (P<0.001), respectively, and the disease-free 5-year survival rates were 63.1%, 30.6%, 24.0% (P<0.001). The CRM was shown to be an independent prognostic factor by multivariate analyses adjusted for known predictors of outcome (P<0.001). CONCLUSIONS: The prognosis for a member of the abutting or the positive CRM group was more unfavorable than it was for a member of the negative CRM group; therefore, measurement of the CRM should be reported in the pathologic report. For patients with an abutting or a positive CRM, neoadjuvant or adjuvant chemoradiotherapy should be considered for better oncologic outcomes.
