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Effect of preoperative chemotherapy on distal spread of low rectal cancer located close to the anus

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to clarify the frequency of distal spread and the optimal distal margin after preoperative chemotherapy for advanced low rectal cancer.

Methods

The study included patients with advanced lower rectal cancer who received preoperative chemotherapy and underwent surgery during 2012–2015. We investigated the distal spread of tumor cells, defined as the distal distance from the intramucosal distal tumor edge to the farthest tumor cells located under the submucosal layer. Clinical characteristics were compared for distal spreads ≥ 10 and < 10 mm, and risk factors for distal spread ≥ 10 mm were investigated.

Results

Of the 71 patients, 42 (59%) showed distal spread. Distal spreads of 1–9, 10–19, and ≥ 20 mm were observed in 27 (38%), 11 (15%), and 4 (6%) patients, respectively. Multivariate analysis revealed two independent risk factors for distal spread ≥ 10 mm after preoperative chemotherapy. The first risk factor is the presence of different therapeutic effects between the mucosal and deeper layers (meaning that superficial tumor shrinkage was evident on colonoscopy, but little tumor shrinkage was evident on magnetic resonance imaging) (odds ratio, 11.6; 95% CI, 2.22–61.3). The second risk factor is poorly differentiated or mucinous adenocarcinoma (odds ratio, 8.86; 95% CI, 1.58–49.9).

Conclusion

A distal margin of 20 mm is required (10 mm is insufficient) for advanced lower rectal cancer patients who receive preoperative chemotherapy followed by surgery. Independent risk factors for distal spread ≥ 10 mm include (1) the presence of different therapeutic effects between mucosal and deeper layers and (2) poorly differentiated or mucinous adenocarcinomas.

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Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan

    Akihiro Kondo, Yuichiro Tsukada, Yuji Nishizawa, Takeshi Sasaki & Masaaki Ito

  2. Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan

    Motohiro Kojima

  3. Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan

    Yasuyuki Suzuki

Authors
  1. Akihiro Kondo
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  2. Yuichiro Tsukada
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  3. Motohiro Kojima
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  4. Yuji Nishizawa
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  5. Takeshi Sasaki
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  6. Yasuyuki Suzuki
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  7. Masaaki Ito
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Contributions

Akihiro Kondo, Yuichiro Tsukada, and Motohiro Kojima collected and interpreted data. Akihiro Kondo, Yuichiro Tsukada, and Masaaki Ito interpreted data and wrote the paper. Yuji Nishizawa, Takeshi Sasaki, Masaaki Ito, and Yasuyuki Suzuki made substantial contributions to the conception and design of the study, and they were involved in drafting the manuscript and revising it critically for important intellectual content. All authors declare that they contributed to this article and that they all approve its final submitted version.

Corresponding author

Correspondence to Masaaki Ito.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Financial disclosure

The authors claim no conflict of interest regarding this manuscript.

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Kondo, A., Tsukada, Y., Kojima, M. et al. Effect of preoperative chemotherapy on distal spread of low rectal cancer located close to the anus. Int J Colorectal Dis 33, 1685–1693 (2018). https://doi.org/10.1007/s00384-018-3159-7

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  • DOI: https://doi.org/10.1007/s00384-018-3159-7

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