Faculty Collaboration Database

High Rate of Positive Circumferential Resection Margins Following Rectal Cancer Surgery: A Call to Action. Ann Surg 2015 Dec;262(6):891-8

Date

10/17/2015

Pubmed ID

26473651

Pubmed Central ID

PMC5260485

DOI

10.1097/SLA.0000000000001391

Scopus ID

2-s2.0-84948710410 (requires institutional sign-in at Scopus site)   127 Citations

Abstract

OBJECTIVES: To identify predictors of positive circumferential resection margin following rectal cancer resection in the United States.

BACKGROUND: Positive circumferential resection margin is associated with a high rate of local recurrence and poor morbidity and mortality for rectal cancer patients. Prior study has shown poor compliance with national rectal cancer guidelines, but whether this finding is reflected in patient outcomes has yet to be shown.

METHODS: Patients who underwent resection for stage I-III rectal cancer were identified from the 2010-2011 National Cancer Database. The primary outcome was a positive circumferential resection margin. The relationship between patient, hospital, tumor, and treatment-related characteristics was analyzed using bivariate and multivariate analysis.

RESULTS: A positive circumferential resection margin was noted in 2859 (17.2%) of the 16,619 patients included. Facility location, clinical T and N stage, histologic type, tumor size, tumor grade, lymphovascular invasion, perineural invasion, type of operation, and operative approach were significant predictors of positive circumferential resection margin on multivariable analysis. Total proctectomy had nearly a 30% increased risk of positive margin compared with partial proctectomy (OR 1.293, 95%CI 1.185-1.411) and a laparoscopic approach had nearly 22% less risk of a positive circumferential resection margin compared with an open approach (OR 0.882, 95%CI 0.790-0.985).

CONCLUSIONS: Despite advances in surgical technique and multimodality therapy, rates of positive circumferential resection margin remain high in the United States. Several tumor and treatment characteristics were identified as independent risk factors, and advances in rectal cancer care are necessary to approach the outcomes seen in other countries.

Author List

Rickles AS, Dietz DW, Chang GJ, Wexner SD, Berho ME, Remzi FH, Greene FL, Fleshman JW, Abbas MA, Peters W, Noyes K, Monson JR, Fleming FJ, Consortium for Optimizing the Treatment of Rectal Cancer (OSTRiCh)

Author

Kirk A. Ludwig MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Adult
Aged
Aged, 80 and over
Databases, Factual
Digestive System Surgical Procedures
Female
Humans
Male
Middle Aged
Multivariate Analysis
Neoplasm Staging
Rectal Neoplasms
Rectum
Risk Factors
Treatment Outcome
United States