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Post-chemoradiation anastomotic recurrence in locally advanced rectal cancer: no increased risk associated with distal margin

Clinical and Translational Oncology volume 16, pages 573–580 (2014)Cite this article

Abstract

Background and purpose

Anastomotic recurrence after radical sphincter-preserving surgery preceded by neoadjuvant therapy in locally advanced rectal cancer is an uncommon event that merits further assessment. The aim of this study is to analyze the effect of preoperative chemoradiation on the risk of anastomotic recurrence. Based on the initial extension of the tumor, we analyzed whether the distal surgical section was calculated through the virtual initial extension of the rectal tumor.

Patients and methods

Eligible patients with locally advanced rectal cancer were offered preoperative chemoradiation, sphincter sparing surgery and intraoperative radiation therapy boost.

Results

180 patients were treated with anterior resection (40 %), low anterior resection (45.6 %) and ultra-low anterior resection (14.4 %). With a median follow-up of 41.1 months (0.36–143 months), anastomotic recurrence was diagnosed in 9 patients (5 %). There was no statistical correlation with downstaging (T or N), downsizing effects, or with distance from the lower limit of the residual lesion to the distal margin. Virtual intratumoral surgical section was speculated in 44 patients (3 developed anastomotic recurrence; 6.8 vs 4.8 %, p = 0.482).

Conclusion

Anastomotic recurrence in patients with rectal cancer treated with neoadjuvant chemoradiation is an infrequent event. Virtual intratumoral surgical sections followed by anastomosis do not contribute to an excessive risk of recurrence. Our findings encourage the development of policies for preservation of the ano-rectal complex in rectal cancer patients.

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Acknowledgments

This study was supported in part by a Grant from the Health Institute of Research Carlos III, Spanish Ministry of Science and Innovation (project code PI11-02908).

Conflict of interest

The authors declare no potential or current commercial conflicts of interest.

Author information

Affiliations

  1. Department of Oncology, Hospital General Universitario Gregorio Marañon, Complutense University, School of Medicine, C/Maiquez 7, 28007, Madrid, Spain

    F. A. Calvo & C. V. Sole

  2. Radiation Oncology Service, Hospital Universitario La Paz, Madrid, Spain

    F. Rivas

  3. Radiation Oncology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    M. Gómez-Espí & R. Herranz

  4. General Surgery Service I, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    E. del Valle & M. Rodríguez

  5. Pathology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    E. Álvarez

Authors
  1. F. A. Calvo
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  2. F. Rivas
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  3. C. V. Sole
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  4. M. Gómez-Espí
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  5. R. Herranz
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  6. E. del Valle
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  7. M. Rodríguez
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Corresponding author

Correspondence to C. V. Sole.

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Calvo, F.A., Rivas, F., Sole, C.V. et al. Post-chemoradiation anastomotic recurrence in locally advanced rectal cancer: no increased risk associated with distal margin. Clin Transl Oncol 16, 573–580 (2014). https://doi.org/10.1007/s12094-013-1119-9

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  • DOI: https://doi.org/10.1007/s12094-013-1119-9

Keywords

  • Neoadjuvant chemoradiation
  • Locally advanced rectal cancer
  • Anastomotic recurrence
  • Downsizing
  • Downstaging
  • Margin distance