Quality of surgery in T3-4 rectal cancer: involvement of circumferential resection margin not influenced by preoperative treatment. Results from EORTC trial 22921

Abstract

Purpose: The present analyses aimed to determine risk factors for rectal cancer patients associated with circumferential resection margin (CRM) and number of examined lymph nodes (LN) and to correlate these parameters of surgical quality with local recurrence (LR), disease-free and overall survival (DFS and OS).

Materials and methods: Data of 884 eligible patients, who underwent a resection and had no metastases at time of surgery, were analysed.

Results: Age, period of treatment, distance and pT-stage were associated with surgical quality. CRM involvement, but not the number of examined LN, was associated with a higher risk of an LR, reduced DFS and OS. An abdomino-perineal resection (APR) was a risk factor for adverse outcome.

Conclusion: Surgical quality is an important predictor of outcome, also for patients treated with conventional RT or chemoradiotherapy (CRT). Preoperative CRT results in downstaging and downsizing of the tumour, but not in less CRM involvement.