Skip to main content

Advertisement

SpringerLink
Log in

Risk factors for circumferential R1 resection after neoadjuvant radiochemotherapy and laparoscopic total mesorectal excision: a study in 233 consecutive patients with mid or low rectal cancer

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to identify risk factors for circumferential R1 resection (R1c) after neoadjuvant radiochemotherapy (RCT) and laparoscopic total mesorectal excision (TME) for mid or low rectal cancer. Better knowledge of pre- or intraoperative risk factors could possibly help for the management of these patients.

Methods

Between 2005 and 2013, 233 consecutive patients undergoing laparoscopic TME for low or mid rectal cancer after RCT were included. R1c resection was defined as a circumferential margin ≤1 mm. Univariate and multivariate analyses were performed to identify independent risk factors for R1c.

Results

Twenty-five patients had R1c resection (11 %). In univariate analysis, low rectal cancer, anterior tumour, T4 on pretherapeutic magnetic resonance imaging (MRI), T4 and/or N+ on post-RCT MRI and operative time >240 min were associated with a significantly increased risk of R1c resection. In multivariate analysis, only T4 on post-RCT MRI (odds ratio (OR) = 6.02 [1.06–33]; p = 0.043) and operative time >240 min. (OR = 5.4 [1.01–28.9]; p = 0.049) were identified as independent risk factors for R1c resection. The risk of R1c resection was 3 % (n = 3/88), 10 % (n = 5/51) or 38 % (n = 3/8) when 0, 1 or 2 risk factors were present in the same patient, respectively.

Conclusion

Patients with T4 on MRI after RCT and/or operative time >240 min. seems to be at higher risk for R1c resection. In a pragmatic approach, we consider that systematic second MRI after RCT could help the surgeon, especially in area where circumferential margin is too short, in order to reduce this risk of R1 resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646

    Article  CAS  PubMed  Google Scholar 

  2. Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123

    Article  CAS  PubMed  Google Scholar 

  3. Gerard JP, Conroy T, Bonnetain F, Bouche O, Chapet O, Closon-Dejardin MT et al (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 24:4620–4625

    Article  PubMed  Google Scholar 

  4. Arbman G, Nilsson E, Hallbook O, Sjodahl R (1996) Local recurrence following total mesorectal excision for rectal cancer. Br J Surg 83:375–379

    Article  CAS  PubMed  Google Scholar 

  5. Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616

    Article  CAS  PubMed  Google Scholar 

  6. Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312

    Article  PubMed  Google Scholar 

  7. Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D et al (1994) Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 344:707–711

    Article  CAS  PubMed  Google Scholar 

  8. Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2:996–999

    Article  CAS  PubMed  Google Scholar 

  9. Caricato M, Borzomati D, Ausania F, Valeri S, Rosignoli A, Coppola R (2006) Prognostic factors after surgery for locally recurrent rectal cancer: an overview. Eur J Surg Oncol 32:126–132

    Article  CAS  PubMed  Google Scholar 

  10. Hall NR, Finan PJ, Al-Jaberi T, Tsang CS, Brown SR, Dixon MF et al (1998) Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence? Dis Colon Rectum 41:979–983

    Article  CAS  PubMed  Google Scholar 

  11. Wibe A, Rendedal PR, Svensson E, Norstein J, Eide TJ, Myrvold HE et al (2002) Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 89:327–334

    Article  CAS  PubMed  Google Scholar 

  12. Debove C, Maggiori L, Chau A, Kanso F, Ferron M, Panis Y (2014) What happens after R1 resection in patients undergoing laparoscopic total mesorectal excision for rectal cancer ? A study in 333 consecutive patients. Color Dis. doi:10.1111/codi.12849

  13. Portier G (2007) [Recommendations for clinical practice. Therapeutic choices for rectal cancer. How should neoadjuvant therapies be chosen?]. Gastroenterol Clin Biol 31 Spec No 1: 1S23-33, 1S89-91

  14. Bretagnol F, Panis Y, Rullier E, Rouanet P, Berdah S, Dousset B et al (2010) Rectal cancer surgery with or without bowel preparation: the French GRECCAR III multicenter single-blinded randomized trial. Ann Surg 252:863–868

    Article  PubMed  Google Scholar 

  15. Washington MK, Berlin J, Branton P, Burgart LJ, Carter DK, Fitzgibbons PL et al (2009) Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med 133:1539–1551

    PubMed Central  PubMed  Google Scholar 

  16. Sobin LH, Wittekind C (2002) TNM classification of malignant tumours, 6th edn. Wiley-Liss, New York

    Google Scholar 

  17. Tilney HS, Tekkis PP, Sains PS, Constantinides VA, Heriot AG (2007) Factors affecting circumferential resection margin involvement after rectal cancer excision. Dis Colon Rectum 50:29–36

    Article  PubMed  Google Scholar 

  18. Phang PT, Kennecke H, McGahan CE, Macfarlane J, McGregor G, Hay JH (2008) Predictors of positive radial margin status in a population-based cohort of patients with rectal cancer. Curr Oncol 15:98–103

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Russell MC, You YN, Hu CY, Cormier JN, Feig BW, Skibber JM et al (2013) A novel risk-adjusted nomogram for rectal cancer surgery outcomes. JAMA Surg 148:769–777

    Article  PubMed Central  PubMed  Google Scholar 

  20. Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT (2003) Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg 90:355–364

    Article  CAS  PubMed  Google Scholar 

  21. Taylor FG, Quirke P, Heald RJ, Moran BJ, Blomqvist L, Swift IR et al (2014) Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study. J Clin Oncol 32:34–43

    Article  PubMed  Google Scholar 

  22. Zhao RS, Wang H, Zhou ZY, Zhou Q, Mulholland MW (2014) Restaging of locally advanced rectal cancer with magnetic resonance imaging and endoluminal ultrasound after preoperative chemoradiotherapy: a systemic review and meta-analysis. Dis Colon Rectum 57:388–395

    Article  PubMed  Google Scholar 

  23. Hanly AM, Ryan EM, Rogers AC, McNamara DA, Madoff RD, Winter DC (2014) Multicenter Evaluation of Rectal cancer ReImaging pOst Neoadjuvant (MERRION) Therapy. Ann Surg 259:723–727

    Article  PubMed  Google Scholar 

  24. Wang C, Xiao Y, Qiu H, Yao J, Pan W (2014) Factors affecting operating time in laparoscopic anterior resection of rectal cancer. World J Surg Oncol 12:44

    Article  PubMed Central  PubMed  Google Scholar 

  25. Akiyoshi T, Kuroyanagi H, Oya M, Konishi T, Fukuda M, Fujimoto Y et al (2009) Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer. Surgery 146:483–489

    Article  PubMed  Google Scholar 

  26. Targarona EM, Balague C, Pernas JC, Martinez C, Berindoague R, Gich I et al (2008) Can we predict immediate outcome after laparoscopic rectal surgery? Multivariate analysis of clinical, anatomic, and pathologic features after 3-dimensional reconstruction of the pelvic anatomy. Ann Surg 247:642–649

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

The authors have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Beaujon Hospital, Assistance publique-Hôpitaux de Paris, Université Paris VII, Clichy, France

    Clotilde Debove, Léon Maggiori, Amélie Chau, Frédéric Kanso, Marianne Ferron & Yves Panis

Authors
  1. Clotilde Debove
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Léon Maggiori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amélie Chau
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Frédéric Kanso
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marianne Ferron
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yves Panis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yves Panis.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Debove, C., Maggiori, L., Chau, A. et al. Risk factors for circumferential R1 resection after neoadjuvant radiochemotherapy and laparoscopic total mesorectal excision: a study in 233 consecutive patients with mid or low rectal cancer. Int J Colorectal Dis 30, 197–203 (2015). https://doi.org/10.1007/s00384-014-2080-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-014-2080-y

Keywords

Search

Navigation