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Distal Bowel Surgical Margin Shorter than 1 cm After Preoperative Radiation for Rectal Cancer: Is It Safe?

Annals of Surgical Oncology volume 15, pages 3124–3131 (2008)Cite this article

Abstract

Background

The primary end-point of our randomized trial was sphincter preservation. The secondary aim was to evaluate whether distal bowel clearance ≤1 cm is safe after radiation.

Methods

The study randomized 312 patients with cT3-4 resectable low-lying and mid-rectal cancer to receive either preoperative irradiation (5 × 5 Gy) with immediate total mesorectal excision (TME) or chemoradiation (50.4 Gy, bolus 5-fluorouracil and leucovorin) with delayed TME. After anterior resection, pathologists prospectively measured macroscopic and microscopic distal bowel clearance.

Results

Macroscopic and microscopic distal bowel clearance, distal intramural spread, sphincter preservation, local control, disease-free survival, and overall survival did not differ in the two randomized groups. Pooled analysis of the two groups showed that the incidence of local recurrence at 4 years (median follow-up) for patients with macroscopic clearance ≤1 cm (n = 42) and >1 cm (n = 124) was 11.3% and 15.4%, respectively (P = 0.514); the hazard ratio (HR) was 0.70, and the 95% confidence interval (CI) was 0.23–2.07. The corresponding values for patients with microscopic clearance ≤1 cm (n = 51) and >1 cm (n = 101) were 9.6% and 17.6% (P = 0.220; HR 0.51; 95% CI 0.17–1.53).

Conclusion

After preoperative radiotherapy, distal bowel clearance ≤1 cm did not compromise local control.

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Acknowledgments

Supported by grant no. 4 P05C 03917 from the Polish State Committee for Scientific Research.

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Affiliations

  1. Department of Colorectal Cancer, The Maria Sklodowska-Curie Memorial Cancer Centre, W. K. Roentgena 5, 02 781, Warsaw, Poland

    Andrzej Rutkowski MD, PhD & Marek P. Nowacki MD, PhD

  2. Department of Radiotherapy, The Maria Sklodowska-Curie Memorial Cancer Centre, W. K. Roentgena 5, 02 781, Warsaw, Poland

    Krzysztof Bujko MD, PhD

  3. Department of Pathology, The Maria Sklodowska-Curie Memorial Cancer Centre, Gliwice, Poland

    Ewa Chmielik MD, PhD

  4. Department of Pathology, The Maria Sklodowska-Curie Memorial Cancer Centre, W. K. Roentgena 5, 02 781, Warsaw, Poland

    Anna Nasierowska-Guttmejer MD, PhD

  5. Department of Pathology, Silesian Oncological Centre, Wroclaw, Poland

    Andrzej Wojnar MD, PhD

Authors
  1. Andrzej Rutkowski MD, PhD
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  2. Krzysztof Bujko MD, PhD
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  3. Marek P. Nowacki MD, PhD
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  4. Ewa Chmielik MD, PhD
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  5. Anna Nasierowska-Guttmejer MD, PhD
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  6. Andrzej Wojnar MD, PhD
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On Behalf of the Polish Colorectal Study Group

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Correspondence to Krzysztof Bujko MD, PhD.

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Rutkowski, A., Bujko, K., Nowacki, M.P. et al. Distal Bowel Surgical Margin Shorter than 1 cm After Preoperative Radiation for Rectal Cancer: Is It Safe?. Ann Surg Oncol 15, 3124–3131 (2008). https://doi.org/10.1245/s10434-008-0125-6

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  • DOI: https://doi.org/10.1245/s10434-008-0125-6

Keywords

  • Local Recurrence
  • Total Mesorectal Excision
  • Preoperative Radiation
  • Sphincter Preservation
  • Distal Resection Margin