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Abdominoperineal resection and low anterior resection: comparison of long-term oncologic outcome in matched patients with lower rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The current study aimed to compare the oncologic outcome and pattern of metastasis after abdominoperineal resection (APR) and low anterior resection (LAR) treating lower rectal cancer.

Methods

A total of 804 patients undergoing curative resection (R0) were enrolled prospectively. The APR and LAR groups (n = 402, respectively) were matched for gender, age, and stage, for a retrospectively comparative analysis.

Results

In a multivariate analysis with potential variables, APR itself was not a risk factor for increased local recurrence (LR) or reduced survival (P = 0.243–0.994). Circumferential resection margin (CRM) involvement as an operation-related risk was 1.6-fold more frequent in the APR group and was significantly associated with LR and systemic recurrence (OR, 2.487–4.017; P < 0.01). Circumferential margin positivity (CRM+) was concurrently correlated with advanced stage, larger tumor (long diameter, >4 cm), and longer sagittal midpelvic diameter (>10 cm) in a multivariate analysis (P < 0.001–0.05). The site of metastasis did not differ between the two groups, with the exception of lung metastasis which was more frequent in the APR group (APR vs. LAR: 15.9 vs. 10 %, P = 0.015). In the APR group, CRM+ and the presence of an infiltrating tumor were correlated with disease-free survival (hazard ratio (HR), 1.644 and 1.654, respectively), whereas elevated serum carcinoembryonic antigen and LVI+ were correlated with overall survival (HR, 1.57 and 1.671, respectively), in a multivariate analysis with potential variables (P < 0.05).

Conclusions

When performed with appropriate skill to achieve R0 resection, APR can be used safely without impairing oncological outcome, although sphincter-preserving surgery should remain the preferred option.

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References

  1. Schoetz DJ Jr (2006) Evolving practice patterns in colon and rectal surgery. J Am Coll Surg 203:322–327

    Article  PubMed  Google Scholar 

  2. Perry WB, Connaughton JC (2007) Abdominoperineal resection: how is it done and what are the results? Clin Colon Rectal Surg 20:213–220

    Article  PubMed  Google Scholar 

  3. Park IJ, Kim JC (2010) Adequate length of the distal resection margin in rectal cancer: from the oncological point of view. J Gastrointest Surg 14:1331–1337

    Article  PubMed  Google Scholar 

  4. Varpe P, Huhtinen H, Rantala A et al (2011) Quality of life after surgery for rectal cancer with special reference to pelvic floor dysfunction. Colorectal Dis 13:399–405

    Article  PubMed  CAS  Google Scholar 

  5. Keating JP (2004) Sexual function after rectal excision. ANZ J Surg 74:248–259

    Article  PubMed  Google Scholar 

  6. Marr R, Birbeck K, Garvican J et al (2005) The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg 242:74–82

    Article  PubMed  Google Scholar 

  7. Nagtegaal ID, van de Velde CJ, Marijnen CA et al (2005) Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol 23:9257–9264

    Article  PubMed  Google Scholar 

  8. Holm T, Ljung A, Häggmark T et al (2007) Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 94:232–238

    Article  PubMed  CAS  Google Scholar 

  9. Brown SR, Seow Choen F (2000) Preservation of rectal function after low anterior resection with formation of a neorectum. Semin Surg Oncol 19:376–385

    Article  PubMed  CAS  Google Scholar 

  10. Bossema E, Stiggelbout A, van de Velde C et al (2008) Patients' preferences for low rectal cancer surgery. Eur J Surg Oncol 34:2–8

    Article  Google Scholar 

  11. Zolciak A, Bujko K, Kepka L et al (2006) Abdominoperineal resection or anterior resection for rectal cancer: patient preferences before and after treatment. Colorectal Dis 8:575–580

    Article  PubMed  CAS  Google Scholar 

  12. Kim JC, Takahashi K, Yu CS et al (2007) Comparative outcome between chemoradiotherapy and lateral pelvic lymph node dissection following total mesorectal excision in rectal cancer. Ann Surg 246:754–762

    Article  PubMed  Google Scholar 

  13. Park JH, Yoon SM, Yu CS et al (2011) Randomized phase 3 trial comparing preoperative and postoperative chemoradiotherapy with capecitabine for locally advanced rectal cancer. Cancer 117:3703–3712

    Article  PubMed  CAS  Google Scholar 

  14. Dworak O, Keilholz L, Hoffmann A (1997) Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis 12:19–23

    Article  PubMed  CAS  Google Scholar 

  15. Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740

    Article  PubMed  CAS  Google Scholar 

  16. Wibe A, Syse A, Andersen E et al (2004) Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection. Dis Colon Rectum 47:48–58

    Article  PubMed  Google Scholar 

  17. Swamy R (2010) Histopathological reporting of pT4 tumour stage in colorectal carcinomas: dotting the ‘i’s and crossing the ‘t’s. J Clin Pathol 63:110–115

    Article  PubMed  CAS  Google Scholar 

  18. Eriksen MT, Wibe A, Haffner J et al (2007) Prognostic groups in 1,676 patients with T3 rectal cancer treated without preoperative radiotherapy. Dis Colon Rectum 50:156–167

    Article  PubMed  Google Scholar 

  19. Nash GM, Weiss A, Dasgupta R et al (2010) Close distal margin and rectal cancer recurrence after sphincter-preserving rectal resection. Dis Colon Rectum 53:1365–1373

    Article  PubMed  Google Scholar 

  20. Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312

    Article  PubMed  Google Scholar 

  21. Tilney HS, Tekkis PP, Sains PS et al (2007) Factors affecting circumferential resection margin involvement after rectal cancer excision. Dis Colon Rectum 50:29–36

    Article  PubMed  Google Scholar 

  22. Homma Y, Hamano T, Otsuki Y et al (2010) Severe tumor budding is a risk factor for lateral lymph node metastasis in early rectal cancers. J Surg Oncol 102:230–234

    Article  PubMed  Google Scholar 

  23. Roh MS, Colangelo LH, O’Connell MJ et al (2009) Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 27:5124–5130

    Article  PubMed  Google Scholar 

  24. West NP, Anderin C, Smith KJ et al (2010) Multicentre experience with extralevator abdominoperineal excision for low rectal cancer. Br J Surg 97:588–599

    Article  PubMed  CAS  Google Scholar 

  25. Miles WE (1971) A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908). CA Cancer J Clin 21:361–364

    Article  PubMed  CAS  Google Scholar 

  26. Benchimol S, Fuks A, Jothy S et al (1989) Carcinoembryonic antigen, a human tumor marker, functions as an intercellular adhesion molecule. Cell 57:27–334

    Article  Google Scholar 

  27. Kim JC, Koo KH, Kim BS et al (1999) Carcino-embryonic antigen may function as a chemo-attractant in colorectal-carcinoma cell lines. Int J Cancer 82:880–885

    Article  PubMed  CAS  Google Scholar 

  28. Gangopadhyay A, Lazure DA, Thomas P (1998) Adhesion of colorectal carcinoma cells to the endothelium is mediated by cytokines from CEA stimulated Kupffer cells. Clin Exp Metastasis 16:703–712

    Article  PubMed  CAS  Google Scholar 

  29. Manfredi S, Lepage C, Hatem C et al (2006) Epidemiology and management of liver metastases from colorectal cancer. Ann Surg 244:254–259

    Article  PubMed  Google Scholar 

  30. Mitry E, Guiu B, Cosconea S et al (2010) Epidemiology, management and prognosis of colorectal cancer with lung metastases: a 30-year population-based study. Gut 59:1383–1388

    Article  PubMed  Google Scholar 

  31. Warwick R, Williams PL (1973) Angiology. In: Warwick R, Williams PL (eds) Gray's anatomy. Saunders, Philadelphia, pp 706–709

    Google Scholar 

  32. Paun BC, Cassie S, MacLean AR et al (2010) Postoperative complications following surgery for rectal cancer. Ann Surg 251:807–818

    Article  PubMed  Google Scholar 

  33. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

    Article  PubMed  CAS  Google Scholar 

  34. Matzel KE, Bittorf B, Günther K et al (2003) Rectal resection with low anastomosis: functional outcome. Colorectal Dis 5:458–464

    Article  PubMed  CAS  Google Scholar 

  35. Enker WE, Havenga K, Polyak T et al (1997) Abdominoperineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancer. World J Surg 21:715–720

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by grants to J. C. Kim from the Asan Institute for Life Sciences (2011-069), the Korea Health 21 R&D Project (A062254), and the Center for Development and Commercialization of Anti-Cancer Therapeutics (A102059), Ministry of Health and Welfare, Republic of Korea.

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Authors and Affiliations

  1. Department of Surgery, University of Ulsan College of Medicine, and Institute of Innovative Cancer Research, Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, 138-736, Seoul, South Korea

    Jin C. Kim, Chang S. Yu, Seok B. Lim & Chan W. Kim

  2. Radiation Oncology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea

    Jong H. Kim

  3. Department of Internal Medicine, University of Ulsan College of Medicine, and Institute of Innovative Cancer Research, Asan Medical Center, Seoul, South Korea

    Tae W. Kim

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  1. Jin C. Kim
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  2. Chang S. Yu
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  3. Seok B. Lim
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  4. Chan W. Kim
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  5. Jong H. Kim
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Correspondence to Jin C. Kim.

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Supplementary Table 1

Multivariate analysis using potentially survival-related factors in the respective group (DOC 51 kb)

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Kim, J.C., Yu, C.S., Lim, S.B. et al. Abdominoperineal resection and low anterior resection: comparison of long-term oncologic outcome in matched patients with lower rectal cancer. Int J Colorectal Dis 28, 493–501 (2013). https://doi.org/10.1007/s00384-012-1590-8

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  • DOI: https://doi.org/10.1007/s00384-012-1590-8

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