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Factors Affecting Circumferential Resection Margin Involvement After Rectal Cancer Excision

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Diseases of the Colon & Rectum

Purpose

This study was designed to assess factors affecting rates of circumferential resection margin involvement after rectal cancer excision, the association between circumferential resection margin involvement rates for patients undergoing anterior resection and abdominoperineal excision within the same unit, and trends in outcomes between units.

Methods

Data about patients undergoing rectal cancer excision between 2000 and 2003 were extracted from the Association of Coloproctology of Great Britain and Ireland database. Multivariate logistic regression analysis was used to identify independent predictors of circumferential resection margin involvement. Pearson correlation coefficient was used to evaluate the association between circumferential resection margin involvement for anterior resection and abdominoperineal excision.

Results

A total of 1,430 patients satisfied the inclusion criteria. The circumferential resection margin involvement rate for anterior resection (n=794) was 6.7 percent, between hospital variability was 0 to 40 percent, and for abdominoperineal excision (n=521) was 17.6 percent, between hospital variability 0 to 100 percent. Independent predictors of circumferential resection margin involvement were T stage (P<0.001), nodal involvement (P=0.007), and operative procedure (P<0.001). Units with a high circumferential resection margin involvement rate for anterior resection also had a high circumferential resection margin involvement rate for abdominoperineal excision (Pearson correlation=0.349; P=0.01).

Conclusions

Circumferential resection margin involvement is more common in lymph-node-positive tumors and is more common after abdominoperineal excision compared with anterior resection. This relationship was consistent across units irrespective of their individual circumferential resection margin involvement rates.

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References

  1. H Ueno H Mochizuki Y Hashiguchi K Hase (2001) ArticleTitlePrognostic determinants of patients with lateral nodal involvement by rectal cancer Ann Surg 234 190–197 Occurrence Handle11505064 Occurrence Handle10.1097/00000658-200108000-00008 Occurrence Handle1:STN:280:DC%2BD3Mvlslymsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  2. IJ Adam MO Mohamdee IG Martin et al. (1994) ArticleTitleRole of circumferential margin involvement in the local recurrence of rectal cancer Lancet 344 707–711 Occurrence Handle7915774 Occurrence Handle10.1016/S0140-6736(94)92206-3 Occurrence Handle1:STN:280:ByuA2MbjtFU%3D

    Article  PubMed  CAS  Google Scholar 

  3. NR Hall PJ Finan T al-Jaberi et al. (1998) ArticleTitleCircumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence? Dis Colon Rectum 41 979–983 Occurrence Handle9715152 Occurrence Handle10.1007/BF02237384 Occurrence Handle1:STN:280:DyaK1czotVyrtg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  4. RJ Heald (1979) ArticleTitleA new approach to rectal cancer Br J Hosp Med 22 277–281 Occurrence Handle391315 Occurrence Handle1:STN:280:Bi%2BD1cfotVY%3D

    PubMed  CAS  Google Scholar 

  5. RJ Heald (1995) ArticleTitleTotal mesorectal excision is optimal surgery for rectal cancer: a Scandinavian consensus Br J Surg 82 1297–1299 Occurrence Handle7489148 Occurrence Handle1:STN:280:BymD1MjotVw%3D

    PubMed  CAS  Google Scholar 

  6. ID Nagtegaal JH Krieken Particlevan (2002) ArticleTitleThe role of pathologists in the quality control of diagnosis and treatment of rectal cancer-an overview Eur J Cancer 38 964–972 Occurrence Handle11978521 Occurrence Handle10.1016/S0959-8049(02)00056-4 Occurrence Handle1:STN:280:DC%2BD383ktVyqsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  7. InstitutionalAuthorNameColorectal Cancer Collaborative Group (2001) ArticleTitleAdjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials Lancet 358 1291–1304 Occurrence Handle10.1016/S0140-6736(01)06409-1

    Article  Google Scholar 

  8. E Kapiteijn CA Marijnen ID Nagtegaal et al. (2001) ArticleTitlePreoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer N Engl J Med 345 638–646 Occurrence Handle11547717 Occurrence Handle10.1056/NEJMoa010580 Occurrence Handle1:STN:280:DC%2BD3Mvps1ektw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  9. M Dahlberg B Glimelius W Graf L Pahlman (1998) ArticleTitlePreoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study Dis Colon Rectum 41 543–551 Occurrence Handle9593234 Occurrence Handle10.1007/BF02235256 Occurrence Handle1:STN:280:DyaK1c3lsVSltA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  10. KC Peeters CJ Velde Particlevan de JW Leer et al. (2005) ArticleTitleLate side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients–a Dutch colorectal cancer group study J Clin Oncol 23 6199–6206 Occurrence Handle16135487 Occurrence Handle10.1200/JCO.2005.14.779 Occurrence Handle1:STN:280:DC%2BD2Mvmslylsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  11. AG Heriot PP Tekkis VW Fazio P Neary IC Lavery (2005) ArticleTitleAdjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancer: a predictive model Ann Surg 242 502–511 Occurrence Handle16192810

    PubMed  Google Scholar 

  12. DP Edwards NJ Mortensen (2001) ArticleTitleIs radiotherapy for rectal cancer indicated if surgery is optimized? Eur J Surg Oncol 27 442–445 Occurrence Handle11504512 Occurrence Handle10.1053/ejso.2000.1083 Occurrence Handle1:STN:280:DC%2BD3MvlslyitA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  13. G Brown AG Radcliffe RG Newcombe NS Dallimore MW Bourne GT Williams (2003) ArticleTitlePreoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging Br J Surg 90 355–364 Occurrence Handle12594673 Occurrence Handle10.1002/bjs.4034 Occurrence Handle1:STN:280:DC%2BD3s%2Fot1Oiug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  14. F Seow-Choen (2002) ArticleTitleAdjuvant therapy for rectal cancer cannot be based on the results of other surgeons Br J Surg 89 946–947 Occurrence Handle12153617 Occurrence Handle10.1046/j.1365-2168.2002.02139.x Occurrence Handle1:STN:280:DC%2BD38vgsVeisw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  15. PP Tekkis AG Heriot J Smith MR Thompson P Finan JD Stamatakis (2005) ArticleTitleComparison of circumferential margin involvement between restorative and nonrestorative resections for rectal cancer Colorectal Dis 7 369–374 Occurrence Handle15932561 Occurrence Handle10.1111/j.1463-1318.2005.00767.x Occurrence Handle1:STN:280:DC%2BD2M3oslOqtg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  16. The Association of Coloproctology of Great Britain and Ireland Database and Dataset. In. Version 2 for Access 2000 UK ed: Clin IT 2000; 2000.

  17. P Quirke P Durdey MF Dixon NS Williams (1986) ArticleTitleLocal recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision Lancet 2 996–999 Occurrence Handle2430152 Occurrence Handle10.1016/S0140-6736(86)92612-7 Occurrence Handle1:STN:280:BiiD3sfjslU%3D

    Article  PubMed  CAS  Google Scholar 

  18. P Quirke MF Dixon (1988) ArticleTitleThe prediction of local recurrence in rectal adenocarcinoma by histopathological examination Int J Colorectal Dis 3 127–131 Occurrence Handle3045231 Occurrence Handle10.1007/BF01645318 Occurrence Handle1:STN:280:BieA3MngtVw%3D

    Article  PubMed  CAS  Google Scholar 

  19. RG Beets-Tan GL Beets (2004) ArticleTitleRectal cancer: review with emphasis on MR imaging Radiology 232 335–346 Occurrence Handle15286305

    PubMed  Google Scholar 

  20. O Will S Purkayastha C Chan et al. (2006) ArticleTitleDiagnostic precision of nanoparticle-enhanced MRI for lymph-node metastases: a meta-analysis Lancet Oncol 7 52–60 Occurrence Handle16389184 Occurrence Handle10.1016/S1470-2045(05)70537-4

    Article  PubMed  Google Scholar 

  21. WE Enker K Havenga T Polyak H Thaler M Cranor (1997) ArticleTitleAbdominoperineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancer World J Surg 21 715–720 Occurrence Handle9276702 Occurrence Handle10.1007/s002689900296 Occurrence Handle1:STN:280:ByiH383msFY%3D

    Article  PubMed  CAS  Google Scholar 

  22. F Lopez-Kostner I Lavery G Hool L Rybicki V Fazio (1998) ArticleTitleTotal mesorectal excision is not necessary for cancers of the upper rectum Surgery 124 612–618 Occurrence Handle9780979 Occurrence Handle10.1067/msy.1998.91361 Occurrence Handle1:STN:280:DyaK1cvlsValtg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  23. P Luna-Perez S Rodriguez-Ramirez J Vega E Sandoval S Labastida (2001) ArticleTitleMorbidity and mortality following abdominoperineal resection for low rectal adenocarcinoma Rev Invest Clin 53 388–395 Occurrence Handle11795103 Occurrence Handle1:STN:280:DC%2BD38%2FmvFShsg%3D%3D

    PubMed  CAS  Google Scholar 

  24. G Arbman E Nilsson O Hallbook R Sjodahl (1996) ArticleTitleLocal recurrence following total mesorectal excision for rectal cancer Br J Surg 83 375–379 Occurrence Handle8665198 Occurrence Handle1:STN:280:BymB2cnis1M%3D

    PubMed  CAS  Google Scholar 

  25. National Institute of Clinical Excellence. Improving outcomes in colorectal cancers: Manual update 2004. Available at: http://www.nice.org.uk/page.aspx?o=CSGCCfullguideline. Accessed January 12, 2006.

  26. SD Killeen MJ O’Sullivan JC Coffey WO Kirwan HP Redmond (2005) ArticleTitleProvider volume and outcomes for oncological procedures Br J Surg 92 389–402 Occurrence Handle15786424 Occurrence Handle10.1002/bjs.4954 Occurrence Handle1:STN:280:DC%2BD2M7mtVWrtA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  27. BR Konety V Dhawan V Allareddy SA Joslyn (2005) ArticleTitleImpact of hospital and surgeon volume on in-hospital mortality from radical cystectomy: data from the health care utilization project J Urol 173 1695–1700 Occurrence Handle15821560 Occurrence Handle10.1097/01.ju.0000154638.61621.03

    Article  PubMed  Google Scholar 

  28. LM Ellison BJ Trock NR Poe AW Partin (2005) ArticleTitleThe effect of hospital volume on cancer control after radical prostatectomy J Urol 173 2094–2098 Occurrence Handle15879850 Occurrence Handle10.1097/01.ju.0000158156.80315.fe Occurrence Handle1:STN:280:DC%2BD2M3ktFKksw%3D%3D

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank and acknowledge the contribution of Jeff Stamatakis, Paul Finan and Michael Thompson whose assistance was pivotal in the project, as well as the following hospitals which contributed patients to the study on which this paper is based: Airedale NHS Trust, Royal Group of Hospitals and Dental Hospital HSS Trust, Borders General Hospital NHS Trust, Bro Morgannwj NHS Trust, Buckinghamshire Hospitals NHS Trust, Calderdale and Huddersfield NHS Trust, Cardiff and Vale NHS Trust, Carmarthenshire NHS Trust, Central Manchester and Manchester Children’s University Hospitals NHS Trust, Chelsea and Westminster Healthcare NHS Trust, East and North Hertfordshire NHS Trust, East Sussex Hospitals NHS Trust, Gateshead Health NHS Trust, Heatherwood and Wexham Park Hospitals NHS Trust, Hereford Hospitals NHS Trust, Homerton University Hospital NHS Trust, James Paget Healthcare NHS Trust, Kettering General Hospital NHS Trust, King’s College Hospital NHS Trust, Kingston Hospital NHS Trust, Lancashire Teaching Hospitals NHS Trust, Leeds Teaching Hospitals NHS Trust, Lewisham Hospital NHS Trust, Mayday Healthcare NHS Trust, Mid Essex Hospital Services NHS Trust, North Bristol NHS Trust, North West London Hospitals NHS Trust, North West Wales NHS Trust, Northern Devon Healthcare NHS Trust, Pembrokeshire and Derwen NHS Trust, Peterborough Hospitals NHS Trust, Poole Hospitals NHS Trust, Portsmouth Hospitals NHS Trust, Royal Bournemouth and Christchurch Hospitals NHS Trust, Royal Free Hampstead NHS Trust, Royal West Sussex NHS Trust, Scarborough and North East Yorkshire Health Care NHS Trust, South Devon Health Care NHS Trust, South Manchester University Hospitals NHS Trust, South Warwickshire General Hospitals NHS Trust, The Whittington Hospital NHS Trust, University College London Hospitals NHS Trust, University Hospitals of Leicester NHS Trust, West Dorset General Hospitals NHS Trust, West Hertfordshire Hospitals NHS Trust, Winchester and Eastleigh Healthcare NHS Trust, Worthing and Southlands Hospitals NHS Trust and Wrightington, Wigan and Leigh NHS Trust.

Author information

Authors and Affiliations

  1. Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary’s Hospital, 10th Floor, QEQM Wing, Praed Street, London, W2 1NY, United Kingdom

    Henry S. Tilney M.R.C.S., Paris P. Tekkis M.D., F.R.C.S., Parvinder S. Sains M.R.C.S., Vasilis A. Constantinides B.Sc., M.B.B.S. & Alexander G. Heriot M.D., F.R.C.S.

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  1. Henry S. Tilney M.R.C.S.
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  2. Paris P. Tekkis M.D., F.R.C.S.
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  3. Parvinder S. Sains M.R.C.S.
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  4. Vasilis A. Constantinides B.Sc., M.B.B.S.
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  5. Alexander G. Heriot M.D., F.R.C.S.
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on behalf of the Association of Coloproctology of Great Britain and Ireland

Corresponding author

Correspondence to Paris P. Tekkis M.D., F.R.C.S..

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Supported by The Health Foundation “Engaging with quality” grant.

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Tilney, H.S., Tekkis, P.P., Sains, P.S. et al. Factors Affecting Circumferential Resection Margin Involvement After Rectal Cancer Excision. Dis Colon Rectum 50, 29–36 (2007). https://doi.org/10.1007/s10350-006-0744-6

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  • DOI: https://doi.org/10.1007/s10350-006-0744-6

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