Circumferential resection margin positivity due to direct or indirect tumour involvement in rectal cancer – a call for better stratification
Background A 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...
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| Veröffentlicht in: | ANZ journal of surgery 2024-05, Vol.94 (5), p.931-937 |
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| container_title | ANZ journal of surgery |
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| creator | Sadien, Iannish D. Ari, Kaso Fernandes, Megan Paddock, Sophie Sington, James Kapur, Sandeep Hernon, James Stearns, Adam T. Shaikh, Irshad A. |
| description | Background
A 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.
Methods
1460 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.
Results
Eighty‐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).
Conclusions
Our 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.
Circumferential resection margin positivity due to direct or indirect tumour involvement leads to very different outcomes. This suggests that better patient stratification is required to guide treatment decisions. |
| doi_str_mv | 10.1111/ans.18851 |
| format | Article |
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A 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.
Methods
1460 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.
Results
Eighty‐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).
Conclusions
Our 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.
Circumferential resection margin positivity due to direct or indirect tumour involvement leads to very different outcomes. This suggests that better patient stratification is required to guide treatment decisions.</description><identifier>ISSN: 1445-1433</identifier><identifier>ISSN: 1445-2197</identifier><identifier>EISSN: 1445-2197</identifier><identifier>DOI: 10.1111/ans.18851</identifier><identifier>PMID: 38156719</identifier><language>eng</language><publisher>Melbourne: John Wiley & Sons Australia, Ltd</publisher><subject>Aged ; Cancer ; Cancer surgery ; circumferential resection margin ; Colorectal cancer ; Disease-Free Survival ; Female ; Histopathology ; Humans ; Kaplan-Meier Estimate ; lymph node ; Male ; Margins of Excision ; Medical prognosis ; Middle Aged ; Multivariate analysis ; Neoplasm Recurrence, Local - epidemiology ; Patients ; positive margin ; rectal cancer ; Rectal Neoplasms - mortality ; Rectal Neoplasms - pathology ; Rectal Neoplasms - surgery ; Rectum ; recurrence ; Retrospective Studies ; Statistical models ; Surgery ; Survival ; Survival Rate ; Tumors</subject><ispartof>ANZ journal of surgery, 2024-05, Vol.94 (5), p.931-937</ispartof><rights>2023 The Authors. published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.</rights><rights>2023 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.</rights><rights>2023. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3481-e931c2ee3b88994b831f6e88115b9287a4b57603e2ed601cf586e2f7e338418d3</cites><orcidid>0000-0002-3367-1252</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fans.18851$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fans.18851$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38156719$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sadien, Iannish D.</creatorcontrib><creatorcontrib>Ari, Kaso</creatorcontrib><creatorcontrib>Fernandes, Megan</creatorcontrib><creatorcontrib>Paddock, Sophie</creatorcontrib><creatorcontrib>Sington, James</creatorcontrib><creatorcontrib>Kapur, Sandeep</creatorcontrib><creatorcontrib>Hernon, James</creatorcontrib><creatorcontrib>Stearns, Adam T.</creatorcontrib><creatorcontrib>Shaikh, Irshad A.</creatorcontrib><title>Circumferential resection margin positivity due to direct or indirect tumour involvement in rectal cancer – a call for better stratification</title><title>ANZ journal of surgery</title><addtitle>ANZ J Surg</addtitle><description>Background
A 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.
Methods
1460 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.
Results
Eighty‐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).
Conclusions
Our 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.
Circumferential resection margin positivity due to direct or indirect tumour involvement leads to very different outcomes. This suggests that better patient stratification is required to guide treatment decisions.</description><subject>Aged</subject><subject>Cancer</subject><subject>Cancer surgery</subject><subject>circumferential resection margin</subject><subject>Colorectal cancer</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Histopathology</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>lymph node</subject><subject>Male</subject><subject>Margins of Excision</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Neoplasm Recurrence, Local - epidemiology</subject><subject>Patients</subject><subject>positive margin</subject><subject>rectal cancer</subject><subject>Rectal Neoplasms - mortality</subject><subject>Rectal Neoplasms - pathology</subject><subject>Rectal Neoplasms - surgery</subject><subject>Rectum</subject><subject>recurrence</subject><subject>Retrospective Studies</subject><subject>Statistical models</subject><subject>Surgery</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>Tumors</subject><issn>1445-1433</issn><issn>1445-2197</issn><issn>1445-2197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kc1u3CAUhVHUKj-TLPoCFVI3zWISrjEYltGof1LULtqsEcbXEZFtpoAnml2foJu-YZ6kTGfSRaWy4Vz4OMA9hLwCdgVlXNspXYFSAo7IKdS1WFagmxcHDTXnJ-QspQfGQEotjskJVyBkA_qU_Fz56Oaxx4hT9nagERO67MNERxvv_UTXIfnsNz5vaTcjzYF2PhaEhkj9dNB5HsO8qzdh2OBYvIqmu61i6ezkMNKnH7-oLcUw0L6cbTHnsppytNn33tndpefkZW-HhBeHeUHu3r_7tvq4vP3y4dPq5nbpeK1giZqDqxB5q5TWdas49BKVAhCtrlRj61Y0knGssJMMXC-UxKpvkHNVg-r4grzd-65j-D5jymb0yeEw2AnDnEylmWaqFrwq6Jt_0Ify1am8znAmpJbAS4cX5HJPuRhSitibdfSlg1sDzOxCMiUk8yekwr4-OM7tiN1f8jmVAlzvgUc_4Pb_Tubm89e95W9A754a</recordid><startdate>202405</startdate><enddate>202405</enddate><creator>Sadien, Iannish D.</creator><creator>Ari, Kaso</creator><creator>Fernandes, Megan</creator><creator>Paddock, Sophie</creator><creator>Sington, James</creator><creator>Kapur, Sandeep</creator><creator>Hernon, James</creator><creator>Stearns, Adam T.</creator><creator>Shaikh, Irshad A.</creator><general>John Wiley & Sons Australia, Ltd</general><general>Blackwell Publishing Ltd</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3367-1252</orcidid></search><sort><creationdate>202405</creationdate><title>Circumferential resection margin positivity due to direct or indirect tumour involvement in rectal cancer – a call for better stratification</title><author>Sadien, Iannish D. ; Ari, Kaso ; Fernandes, Megan ; Paddock, Sophie ; Sington, James ; Kapur, Sandeep ; Hernon, James ; Stearns, Adam T. ; Shaikh, Irshad A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3481-e931c2ee3b88994b831f6e88115b9287a4b57603e2ed601cf586e2f7e338418d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Cancer</topic><topic>Cancer surgery</topic><topic>circumferential resection margin</topic><topic>Colorectal cancer</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Histopathology</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>lymph node</topic><topic>Male</topic><topic>Margins of Excision</topic><topic>Medical prognosis</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Neoplasm Recurrence, Local - epidemiology</topic><topic>Patients</topic><topic>positive margin</topic><topic>rectal cancer</topic><topic>Rectal Neoplasms - mortality</topic><topic>Rectal Neoplasms - pathology</topic><topic>Rectal Neoplasms - surgery</topic><topic>Rectum</topic><topic>recurrence</topic><topic>Retrospective Studies</topic><topic>Statistical models</topic><topic>Surgery</topic><topic>Survival</topic><topic>Survival Rate</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sadien, Iannish D.</creatorcontrib><creatorcontrib>Ari, Kaso</creatorcontrib><creatorcontrib>Fernandes, Megan</creatorcontrib><creatorcontrib>Paddock, Sophie</creatorcontrib><creatorcontrib>Sington, James</creatorcontrib><creatorcontrib>Kapur, Sandeep</creatorcontrib><creatorcontrib>Hernon, James</creatorcontrib><creatorcontrib>Stearns, Adam T.</creatorcontrib><creatorcontrib>Shaikh, Irshad A.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>ANZ journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sadien, Iannish D.</au><au>Ari, Kaso</au><au>Fernandes, Megan</au><au>Paddock, Sophie</au><au>Sington, James</au><au>Kapur, Sandeep</au><au>Hernon, James</au><au>Stearns, Adam T.</au><au>Shaikh, Irshad A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Circumferential resection margin positivity due to direct or indirect tumour involvement in rectal cancer – a call for better stratification</atitle><jtitle>ANZ journal of surgery</jtitle><addtitle>ANZ J Surg</addtitle><date>2024-05</date><risdate>2024</risdate><volume>94</volume><issue>5</issue><spage>931</spage><epage>937</epage><pages>931-937</pages><issn>1445-1433</issn><issn>1445-2197</issn><eissn>1445-2197</eissn><abstract>Background
A 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.
Methods
1460 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.
Results
Eighty‐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).
Conclusions
Our 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.
Circumferential resection margin positivity due to direct or indirect tumour involvement leads to very different outcomes. This suggests that better patient stratification is required to guide treatment decisions.</abstract><cop>Melbourne</cop><pub>John Wiley & Sons Australia, Ltd</pub><pmid>38156719</pmid><doi>10.1111/ans.18851</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-3367-1252</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Cancer Cancer surgery circumferential resection margin Colorectal cancer Disease-Free Survival Female Histopathology Humans Kaplan-Meier Estimate lymph node Male Margins of Excision Medical prognosis Middle Aged Multivariate analysis Neoplasm Recurrence, Local - epidemiology Patients positive margin rectal cancer Rectal Neoplasms - mortality Rectal Neoplasms - pathology Rectal Neoplasms - surgery Rectum recurrence Retrospective Studies Statistical models Surgery Survival Survival Rate Tumors |
| title | Circumferential resection margin positivity due to direct or indirect tumour involvement in rectal cancer – a call for better stratification |
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