Skip to main content

Advertisement

SpringerLink
Log in

The clinical significance of distal spread differs according to the primary tumor location in rectal cancer

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Treatment strategies of rectal cancer differ between tumors located above (RS/Ra) and below (Rb) the peritoneal reflection. Based on the extent of distal spread (DS), the Japanese Society for Cancer of Colon and Rectum proposed an optimal distal margin in RS/Ra and Rb tumors. In this study, we investigated the clinical significance of DS between RS/Ra and Rb tumors.

Methods

We analyzed 287 stage I–III rectal cancer patients who underwent curative intent resection without preoperative therapy. DS and other pathological factors were evaluated using whole-mount sections. To investigate the clinical significance of DS in RS/Ra and Rb tumors, clinicopathological variables, including DS, were analyzed for the survival outcome according to the tumor group.

Results

DS was detected in 20 out of 185 (11%) patients with RS/Ra tumors and 8 out of 102 (8%) patients with Rb tumors. DS was not significantly associated with the overall survival (OS) or relapse-free survival (RFS) in RS/Ra tumors, but was an independent prognostic factor for the OS and RFS in Rb tumors (P = 0.002 and 0.007, respectively).

Conclusions

The clinical significance of DS differs between RS/Ra and Rb tumors. DS is associated with a worse survival in Rb tumors, but not in RS/Ra tumors.

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

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Sugihara K, Kusunoki M, Japanese Society for Cancer of the Colon and Rectum [JSCCR]. Japanese classification of colorectal carcinomam. 2nd ed. Tokyo: Kanehara; 2009.

    Google Scholar 

  2. Watanabe T, Muro K, Ajioka Y, Hashiguchi Y, Ito Y, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol. 2018;23:1–34.

    Article  Google Scholar 

  3. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol. 2015;20:207–39.

    Article  Google Scholar 

  4. Sauer I, Bacon HE. Influence of lateral spread of cancer of the rectum on radicability of operation and prognosis. Am J Surg. 1951;81:111–20.

    Article  CAS  Google Scholar 

  5. Fujita S, Mizusawa J, Kanemitsu Y, Ito M, Kinugasa Y, Komori K, et al. Mesorectal excision with or without lateral lymph node dissection for clinical stage II/III lower rectal cancer (JCOG0212): a multicenter, randomized controlled, noninferiority trial. Ann Surg. 2017;266:201–7.

    Article  Google Scholar 

  6. Ono C, Yoshinaga K, Enomoto M, Sugihara K. Discontinuous rectal cancer spread in the mesorectum and the optimal distal clearance margin in situ. Dis Colon Rectum. 2002;45:744–9.

    Article  Google Scholar 

  7. Shimada Y, Takii Y, Maruyama S, Ohta T. Intramural and mesorectal distal spread detected by whole-mount sections in the determination of optimal distal resection margin in patients undergoing surgery for rectosigmoid or rectal cancer without preoperative therapy. Dis Colon Rectum. 2011;54:1510–20.

    Article  Google Scholar 

  8. Shirouzu K, Isomoto H, Kakegawa T. Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery. Cancer. 1995;76:388–92.

    Article  CAS  Google Scholar 

  9. Williams NS, Dixon MF, Johnston D. Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients’ survival. Br J Surg. 1983;70:150–4.

    Article  CAS  Google Scholar 

  10. Vernava AM 3rd, Moran M, Rothenberger DA, Wong WD. A prospective evaluation of distal margins in carcinoma of the rectum. Surg Gynecol Obstet. 1992;175:333–6.

    PubMed  Google Scholar 

  11. Wilson SM, Beahrs OH. The curative treatment of carcinoma of the sigmoid, rectosigmoid, and rectum. Ann Surg. 1976;183:556–65.

    Article  CAS  Google Scholar 

  12. Madsen PM, Christiansen J. Distal intramural spread of rectal carcinomas. Dis Colon Rectum. 1986;29:279–82.

    Article  CAS  Google Scholar 

  13. Nakagoe T, Yamaguchi E, Tanaka K, Sawai T, Tsuji T, Shibasaki S, et al. Distal intramural spread is an independent prognostic factor for distant metastasis and poor outcome in patients with rectal cancer: a multivariate analysis. Ann Surg Oncol. 2003;10:163–70.

    Article  Google Scholar 

  14. Park IJ, Kim JC. Adequate length of the distal resection margin in rectal cancer: from the oncological point of view. J Gastrointest Surg. 2010;14:1331–7.

    Article  Google Scholar 

  15. Amin MB, Edge SB, Greene FL, Byrd DR, Brookland RK, Washington MK, et al., editors. AJCC cancer staging manual. 8th ed. New York: Springer; 2017.

    Google Scholar 

  16. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg. 1982;69:613–6.

    Article  CAS  Google Scholar 

  17. Mezhir JJ, Shia J, Riedel E, Temple LK, Nash GM, Weiser MR, et al. Whole-mount pathologic analysis of rectal cancer following neoadjuvant therapy: implications of margin status on long-term oncologic outcome. Ann Surg. 2012;256:274–9.

    Article  Google Scholar 

  18. Guillem JG, Chessin DB, Shia J, Suriawinata A, Riedel E, Moore HG, et al. A prospective pathologic analysis using whole-mount sections of rectal cancer following preoperative combined modality therapy: implications for sphincter preservation. Ann Surg. 2007;245:88–93.

    Article  Google Scholar 

  19. Moore HG, Riedel E, Minsky BD, Saltz L, Paty P, Wong D, et al. Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapy. Ann Surg Oncol. 2003;10:80–5.

    Article  Google Scholar 

  20. Rutkowski A, Bujko K, Nowacki MP, Chmielik E, Nasierowska-Guttmejer A, Wojnar A, et al. Distal bowel surgical margin shorter than 1 cm after preoperative radiation for rectal cancer: is it safe? Ann Surg Oncol. 2008;15:3124–31.

    Article  Google Scholar 

  21. Watanabe T, Kazama S, Nagawa H. A 1 cm distal bowel margin is safe for rectal cancer after preoperative radiotherapy. Hepatogastroenterology. 2012;59:1068–74.

    CAS  PubMed  Google Scholar 

  22. Kondo A, Tsukada Y, Kojima M, Nishizawa Y, Sasaki T, Suzuki Y, et al. Effect of preoperative chemotherapy on distal spread of low rectal cancer located close to the anus. Int J Colorect Dis. 2018;33:1685–93.

    Article  Google Scholar 

  23. Kinoshita O, Nakanishi M, Murayama Y, Kuriu Y, Kokuba Y, Otsuji E. Flattened tumor requires a more careful attention for residual distal cancer spread in locally advanced lower rectal carcinoma after chemoradiotherapy. Dig Surg. 2015;32:159–65.

    Article  CAS  Google Scholar 

  24. Guedj N, Maggiori L, Poté N, Norkowski E, Cros J, Bedossa P, et al. Distal intramural and tumor spread in the mesorectum after neoadjuvant radiochemotherapy in rectal cancer: about 124 consecutive patients. Hum Pathol. 2016;52:164–72.

    Article  Google Scholar 

  25. Scott N, Jackson P, Al-Jaberi T, Dixon MF, Quirke P, Finan PJ. Total mesorectal excision and local recurrence: a study of tumour spread in the mesorectum distal to rectal cancer. Br J Surg. 1995;82:1031–3.

    Article  CAS  Google Scholar 

  26. Reynolds JV, Joyce WP, Dolan J, Sheahan K, Hyland JM. Pathological evidence in support of total mesorectal excision in the management of rectal cancer. Br J Surg. 1996;83:1112–5.

    Article  CAS  Google Scholar 

  27. Hida J, Yasutomi M, Maruyama T, Fujimoto K, Uchida T, Okuno K. Lymph node metastases detected in the mesorectum distal to carcinoma of the rectum by the clearing method: justification of total mesorectal excision. J Am Coll Surg. 1997;184:584–8.

    CAS  PubMed  Google Scholar 

  28. Zhao GP, Zhou ZG, Lei WZ, Yu YY, Wang C, Wang Z, et al. Pathological study of distal mesorectal cancer spread to determine a proper distal resection margin. World J Gastroenterol. 2005;11:319–22.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan

    Kaoru Abe, Yoshifumi Shimada, Hidehito Oyanagi, Ryoma Yagi, Masato Nakano, Hitoshi Kameyama & Toshifumi Wakai

  2. Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan

    Hitoshi Nogami, Satoshi Maruyama & Yasumasa Takii

Authors
  1. Kaoru Abe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshifumi Shimada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hidehito Oyanagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryoma Yagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masato Nakano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hitoshi Kameyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hitoshi Nogami
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Satoshi Maruyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yasumasa Takii
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Toshifumi Wakai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshifumi Shimada.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abe, K., Shimada, Y., Oyanagi, H. et al. The clinical significance of distal spread differs according to the primary tumor location in rectal cancer. Surg Today 50, 360–368 (2020). https://doi.org/10.1007/s00595-019-01882-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-019-01882-x

Keywords

Search

Navigation