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The significance of extramural venous invasion in R1 positive rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

Evidence has shown that a positive resection margin (R1) is a key determinant of subsequent local recurrence and a poor prognostic factor in rectal cancer. The aim of this study was to evaluate the outcomes and prognosticators in patients with R1 resection of rectal cancer.

Material and methods

Retrospective study of all patients operatively managed within our institution between April 2008 and April 2013 for rectal cancer. Baseline demographics and multiple outcome measures recorded. Overall survival (OS), disease-free survival (DFS) and recurrence were the primary outcome measures.

Results

Overall, there were 306 primary rectal cancers. Seventy-six percent were grade T3/4 tumours. OS was 30 months. R1 rate was 16 % (48 patients). Thirty-one patients underwent APR and 17 AR. In patients who responded to neoadjuvant chemotherapy (NAC), overall survival was 55 months, with no extramural venous invasion (EMV) seen in this cohort. In non-responders OS was 29 months, with EMV in 48 %. In patients who did not receive NAC, OS was 23 months, with EMV in 74 %. EMV is a strong predictor for poor survival following R1 (p = 0.001). We also found a correlation between number of positive nodes and OS/DFS (p = 0.004).

Conclusions

In this small cohort of patients with R1 positive rectal cancers, response to NAC is the strongest predictor of poor overall and disease-free survival. In patients who respond to NAC, OS and DFS has been shown to be positive, with a reduced rate of EMV.

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References

  1. Cancer Research UK Bowel. Cancer statistics http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer#heading-One. Assessed 21 Oct 2015.

  2. Bhangu A, Beynon J, Brown G, Chang G, Das P, Desai A et al. 2013 Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. 100:1009–1014

  3. Luna-Pérez P, Bustos-Cholico E, Alvarado I, Maffuz A, Rodríguez-Ramírez S, Gutiérrez de la Barrera M et al (2005) Prognostic significance of circumferential margin involvement in rectal adenocarcinoma treated with preoperative chemoradiotherapy and low anterior resection. J Surg Oncol. United States 90:20–25

    Article  Google Scholar 

  4. Bujko K, Rutkowski A, Chang GJ, Michalski W, Chmielik E, Kusnierz J (2012) Is the 1-cm rule of distal bowel resection margin in rectal cancer based on clinical evidence? A systematic review. Ann Surg Oncol United States 19:801–808

    Article  Google Scholar 

  5. Debove C, Maggiori L, Chau A, Kanso F, Ferron M, and Panis Y. 2014 What happens after R1 resection in patients undergoing laparoscopic total mesorectal excision for rectal cancer? A study in 333 consecutive patients. Colorectal Dis 25

  6. Mawdsley S, Glynne-Jones R, Grainger J, Richman P, Makris A, Harrison M et al (2005) Can histopathologic assessment of circumferential margin after preoperative pelvic chemoradiotherapy for T3-T4 rectal cancer predict for 3-year disease-free survival? Int J Radiat Oncol Biol Phys United States 63:745–752

    Article  Google Scholar 

  7. Bhangu A, Ali SM, Cunningham D, Brown G, Tekkis P (2013) Comparison of long-term survival outcome of operative vs nonoperative management of recurrent rectal cancer. Colorectal Dis England 15:156–163

    Article  CAS  Google Scholar 

  8. Bhangu A, Ali SM, Darzi A, Brown G, Tekkis P (2012) Meta-analysis of survival based on resection margin status following surgery for recurrent rectal cancer. Colorectal Dis. England 14:1457–1466

    Article  CAS  Google Scholar 

  9. Birbeck KF, Macklin CP, Tiffin NJ, Parsons W, Dixon MF, Mapstone NP et al (2002) Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg United States 235:449–457

    Article  Google Scholar 

  10. Radcliffe A (2006) Can the results of anorectal (abdominoperineal) resection be improved: are circumferential resection margins too often positive? Colorectal Dis. England 8:160–167

    Article  CAS  Google Scholar 

  11. Chambers W, Khan A, Waters R, Lindsey I, George B, Mortensen N et al (2010) Examination of outcome following abdominoperineal resection for adenocarcinoma in Oxford. Colorectal Dis. England 12:1192–1197

    Article  CAS  Google Scholar 

  12. Rullier E, Denost Q, Vendrely V, Rullier A, Laurent C (2013) Low rectal cancer: classification and standardization of surgery. Dis Colon rectum United States 56:560–567

  13. Fekete Z, Muntean A, Irimie A, Hica S, Resiga L, Todor N et al (2013) What is the significance of a microscopically positive resection margin in the curative-intent treatment of rectal adenocarcinoma? A retrospective study. J BUON Greece 18:989–995

    CAS  Google Scholar 

  14. Hyngstrom JR, Tzeng CW, Beddar S, Das P, Krishnan S, Delclos ME et al (2014) Intraoperative radiation therapy for locally advanced primary and recurrent colorectal cancer: ten-year institutional experience. J Surg Oncol United States 109:652–658

    Article  Google Scholar 

  15. Tan J, Heriot AG, Mackay J, Van Dyk S, Bressel MA, Fox CD et al (2013) Prospective single-arm study of intraoperative radiotherapy for locally advanced or recurrent rectal cancer. J Med Imaging Radiat Oncol Australia 57:617–625

    Article  Google Scholar 

  16. Platell C, Spilsbury K (2014) Influence of local recurrence on survival in patients with rectal cancer. ANZ J Surg Australia 84:85–90

    Article  Google Scholar 

  17. Simpson GS, Eardley N, McNicol F, Healey P, Hughes M, Rooney PS (2014) Circumferential resection margin (CRM) positivity after MRI assessment and adjuvant treatment in 189 patients undergoing rectal cancer resection. Int J Colorectal Dis Germany 29:585–590

    Article  CAS  Google Scholar 

  18. Junginger T, Gönner U, Trinh TT, Lollert A, Oberholzer K, Berres M (2010) Permanent stoma after low anterior resection for rectal cancer. Dis Colon rectum. United States 53:1632–1639

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Authors and Affiliations

  1. Department of Colorectal Surgery, St Helens and Knowsley NHS Trust, Warrington Rd, Merseyside, L35 5DR, UK

    N. M. Ormsby, H. N. Bermingham, H. M. Joshi, M. Chadwick, A. Samad, D. Maitra, M. Scott, S. Kelly, K. Whitmarsh & R. Rajaganeshan

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  1. N. M. Ormsby
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  2. H. N. Bermingham
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  3. H. M. Joshi
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  4. M. Chadwick
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  5. A. Samad
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  6. D. Maitra
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  7. M. Scott
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  8. S. Kelly
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  9. K. Whitmarsh
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  10. R. Rajaganeshan
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Correspondence to N. M. Ormsby.

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We have read and understood the IJCD policy on declaration of interests and declare that we have no competing interests.

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Ormsby, N.M., Bermingham, H.N., Joshi, H.M. et al. The significance of extramural venous invasion in R1 positive rectal cancer. Int J Colorectal Dis 32, 119–124 (2017). https://doi.org/10.1007/s00384-016-2658-7

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  • DOI: https://doi.org/10.1007/s00384-016-2658-7

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