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The Impact of Tumour Distance From the Anal Verge on Clinical Management and Outcomes in Patients Having a Curative Resection for Rectal Cancer

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Aim

The clinico-oncological significance of the distance of rectal cancer from the anal verge is unclear and not well reported. The aim of this study is to assess the influence of the rectal cancer distance from the anal verge on clinical management and long-term outcomes after curative resection in a specialised colorectal cancer unit.

Methods

Prospectively collected data on patients who underwent primary rectal cancer treatment at our unit between January 2005 and December 2010 were analysed. Low rectal cancer (LRC) was defined as tumour < 5 cm from the anal verge on MRI scan. Recurrent cancer, palliative resections, perforated tumours and those requiring total pelvic exenteration were excluded.

Results

Three hundred fifty-nine patients underwent surgery for rectal cancer (226 male/133 female). Of these, 149 (41.5%) patients had low rectal cancer (LRC). Compared to patients with mid/upper rectal cancer (M/URC), patients with low rectal cancers were significantly more likely to receive neo-adjuvant therapy (75.2 vs 38%; p < 0.001), to be associated with lower rate of restorative surgery (15.4 vs 79%; p < 0.001) and to have higher rates of pathological positive circumferential resection margin involvement (14.1 vs 7.1%; p = 0.047). There were however no significant difference in the rates of recurrent disease or survival among the two groups.

Conclusion

Distance of rectal cancer from the anal verge does influence the use of neo-adjuvant treatment and ultimate R0 resection rate. It does not influence loco-regional or systemic recurrence rates.

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Acknowledgements

Thanks to Alison Massam from the HES and IT Department, St James’ Hospital Leeds, and Edward Bolton from Cancer Registry (NYCRIS), Leeds, UK, for their help in data collection.

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Authors and Affiliations

  1. The John Goligher Unit of Coloproctology, St. James’s Hospital, Leeds, LS9 7TF, UK

    Muhammad Amir Saeed Khan, Chin W. Ang, Abdul Rahman Hakeem, Rick Nigel Saunders & Ian Botterill

  2. Department of Pathology, St James’s Hospital, Leeds, LS9 7TF, UK

    Nigel Scott

Authors
  1. Muhammad Amir Saeed Khan
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  2. Chin W. Ang
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  3. Abdul Rahman Hakeem
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  4. Nigel Scott
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  5. Rick Nigel Saunders
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  6. Ian Botterill
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Contributions

The concept and study design was by IB, RS and MASK. Data was collected and analysed by MASK and ARH. MASK and CWA wrote the manuscript. The manuscript was reviewed and amended by NS, RS and IB. Pathology input was by NS.

Corresponding author

Correspondence to Muhammad Amir Saeed Khan.

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Conflict of Interest

The authors declare that they have no conflict of interest.

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None.

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What Does This Paper Add to the Literature?

Patients with low rectal cancers are significantly more likely to be treated with neo-adjuvant therapy, to be associated with non-restorative surgery and to have a higher incidence of positive circumferential resection margin compared to patients with mid/upper rectal cancers. However, the distance of rectal cancer from anal verge did not impact on the loco-regional or systemic recurrence rates and disease-free survival (DFS) and overall survival (OS).

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Khan, M.A.S., Ang, C.W., Hakeem, A.R. et al. The Impact of Tumour Distance From the Anal Verge on Clinical Management and Outcomes in Patients Having a Curative Resection for Rectal Cancer. J Gastrointest Surg 21, 2056–2065 (2017). https://doi.org/10.1007/s11605-017-3581-0

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  • DOI: https://doi.org/10.1007/s11605-017-3581-0

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