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The clinical significance of a pathologically positive lymph node at the circumferential resection margin in rectal cancer

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Abstract

Background

This study aimed to determine if the nature of circumferential resection margin (CRM) involvement, either by tumour or lymph nodes, had an impact upon local recurrence and survival in rectal cancer.

Methods

A retrospective analysis of a prospectively collected database was performed. Consecutive patients with stage I-III rectal cancer having curative surgery were included. All specimens were analysed by a single histopathologist. Statistical analysis was performed using chi-squared test and Kaplan–Meier.

Results

Of 265 patients, 29 (11%) had a positive CRM. Compared to patients with a negative CRM, a positive margin due to tumour was associated with a higher 5-year cumulative incidence of local recurrence (43.7% versus 8.8%, p = 0.001) and distant metastases (62% versus 13.6%, p = 0.001) with poorer 5-year cancer-specific survival (32% versus 87.8%, p = 0.001). Although patients with margin positivity due to lymph nodes had a higher rate of distant metastases (41.3% versus 13.6%, p = 0.004) and poorer 5-year cancer-specific survival (59.3% versus 87.8%, p = 0.038), the rate of local recurrence was comparable to that of patients with negative margins (8.3% versus 8.8%, p = 0.694).

Conclusions

Our findings suggest that the nature of CRM involvement may be important in determining prognosis in rectal cancer. Local recurrence is higher only when there is tumour present at the margin. Lymph node involvement of the margin confers similar risk of local recurrence to patients with CRM-negative, node-positive disease. These results need further evaluation in multicentre, prospective studies.

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Acknowledgements

We would like to thank the colorectal multidisciplinary teams at Heartlands Hospital and Good Hope Hospital who were responsible for treating the patients investigated in this study.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Good Hope Hospital, Heart of England NHS Foundation Trust, Rectory Road, Sutton Coldfield, Birmingham, B75 7RR, UK

    A. Patel, N. Green, P. Sarmah, G. Langman & H. Youssef

  2. Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK

    K. Chandrakumaran

Authors
  1. A. Patel
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  2. N. Green
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  3. P. Sarmah
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  4. G. Langman
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  5. K. Chandrakumaran
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  6. H. Youssef
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Correspondence to A. Patel.

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The authors declare that they have no conflict of interest.

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This study does not require direct contact with human participants or animals.

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Patel, A., Green, N., Sarmah, P. et al. The clinical significance of a pathologically positive lymph node at the circumferential resection margin in rectal cancer. Tech Coloproctol 23, 151–159 (2019). https://doi.org/10.1007/s10151-019-01947-6

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  • DOI: https://doi.org/10.1007/s10151-019-01947-6

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