Scientific paperEffects of positive resection margin and tumor distance from anus on rectal cancer treatment outcomes
Section snippets
Methods
We conducted a retrospective review of all rectal cancers in British Columbia in the calendar year 1996. All cancers of the rectum or rectosigmoid junction were identified from the BC Cancer Registry. Four hundred and ninety-five cases were identified as rectal or rectosigmoid adenocarcinoma, diagnosed in a BC resident in 1996 and treated in BC. Information was judged too incomplete for analysis in 14 cases, leaving 481 evaluable cases. These 14 cases were for subjects who were not referred to
Results
At 4 years, disease-specific survival was dependent on stage. Stage 1 cancer had a 91% survival (n = 134) and in situ cancer had a 100% survival (n = 29). In contrast, stage 4 cancer had a 17% survival rate (n = 83). Stages 2 and 3 cancers had survival rates of 78% and 72%, respectively (n = 107, 100). There were 28 cancers for which staging information was unknown. This group with unknown stage had a 15% survival rate. At 4 years, local recurrence rates were 0% for in situ cancer, 7% for stage
Comments
We found that positive resection margin and tumor distance from the anus affect survival and local recurrence. As well, adjuvant postoperative combined radiation and chemotherapy improved survival and decreased local recurrence.
Here, we verify that presence of residual disease affects survival. However, we have identified two potential problems calling patients curative or margin positive. First, we lacked standardized pathology reporting. While the majority of pathology reports assessed
References (14)
- et al.
The prediction of local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision
Lancet
(1986) - et al.
Role of circumferential margin involvement in the local recurrence of rectal cancer
Lancet
(1994) - et al.
The pathologist and the residual tumour, R, classification
Path Res Pract
(1994) - et al.
Preoperative radiation and chemotherapy in the treatment of adenocarcinoma of the rectum
Ann Surg
(1995) - et al.
Preoperative chemoradiation for stages II and III rectal carcinoma
Arch Surg
(1996) - et al.
Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer
N Engl J Med
(2001) Adjuvant therapy for patients with colon and rectal cancer
JAMA
(1990)
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