Circumferential resection margin positivity due to direct or indirect tumour involvement in rectal cancer – a call for better stratification

Author:

Sadien Iannish D.12ORCID,Ari Kaso1,Fernandes Megan1,Paddock Sophie1,Sington James3,Kapur Sandeep1,Hernon James14,Stearns Adam T.14,Shaikh Irshad A.14

Affiliation:

1. Sir Thomas Browne Academic Colorectal Unit Norfolk and Norwich University Hospital Trust Norwich UK

2. Cancer Research UK Cambridge Institute University of Cambridge Cambridge UK

3. Department of Pathology Norfolk and Norwich University Hospital Trust Norwich UK

4. Norwich Medical School University of East Anglia Norwich UK

Abstract

AbstractBackgroundA positive circumferential resection margin (CRM) after rectal cancer surgery, which can be the result of direct or indirect tumour involvement, has consistently been associated with increased local recurrence and poorer survival. However, little is known of the differential impact of the mode of tumour involvement on outcomes.Methods1460 consecutive patients undergoing rectal cancer resection between 2003 and 2018 were retrospectively assessed. Histopathology reports for patients with a positive CRM were reviewed to determine cases of direct (R1‐tumour) or indirect tumour involvement (R1‐other). Disease‐free survival (DFS) and overall survival (OS) were assessed by Kaplan–Meier analysis. The role of the mode of CRM positivity was examined by univariate and multivariate Cox proportional hazards models.ResultsEighty‐five patients had an R1 resection due to CRM involvement (5.8%). Of those, 69 were due to direct tumour involvement, while 16 were from indirect causes. Kaplan–Meier analysis revealed that R1‐other was associated with increased OS (hazard ratio 0.40, log‐rank P = 0.006) and DFS (P = 0.043). Multivariate regression confirmed that the mode of CRM positivity was an independent predictor of OS. More interestingly, the patterns of recurrence were different between the two groups, with R1‐tumour leading to significantly more local recurrence (P = 0.04).ConclusionsOur data strongly suggests that direct tumour involvement of the CRM confers worse prognosis after rectal cancer surgery. Importantly, differences in the site and frequency of recurrences make a case for better stratification of patients with a positive CRM to guide treatment decisions.

Publisher

Wiley

Subject

General Medicine,Surgery

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