Oncologic outcomes in rectal cancer with close distal resection margins: a retrospective analysis

Abstract

Purpose: The assurance of a negative resection margin is significant in rectal cancer as it indicates a reduced risk of local recurrence; thus, sufficient length of the resection margin is strongly required. The purpose of this study was to analyze the relationship between the length of the distal resection margin (DRM) and local recurrence or survival rate and to evaluate the possibility of performing sphincter-conserving surgery.

Methods: The medical records of 218 rectal cancer patients were analyzed. Patients were classified into three groups according to the length of the DRM as follows: group 1, DRM < 1 cm; group 2, 1 cm ≤ DRM ≤ 2 cm; and group 3, DRM > 2 cm.

Results: Of 218 patients enrolled, 81 were in group 1, 66 in group 2, and 71 in group 3. The 5-year survival rates were 78.2%, 78.2%, and 76.8% for groups 1, 2, and 3, respectively, and there were no statistically significant differences in survival (P = 0.913). Local recurrence was found in 2 patients in group 1, 1 patient in group 2, and 1 patient in group 3; there were no statistically significant differences in local recurrence (P = 0.908).

Conclusion: A DRM of < 1 cm did not impair the oncologic outcomes of rectal cancer patients. Our results indicated that surgeons should keep in mind to consider the option of sphincter-conserving surgery with adjuvant chemoradiotherapy even in very low rectal cancer.

Keywords: Local neoplasm recurrence; Rectal neoplasms; Specimen; Survival.

Fig. 1. Univariate analysis of survival rate: (A) survival rate, (B) local recurrence-free survival rate. No statistically significant differences in 5-year overall survival and local recurrence-free survival were observed among the three groups in the univariate analysis.

Fig. 2. Multivariate analysis of survival rates in the three patient groups: (A) Survival rate, (B) local recurrence-free survival rate. No statistically significant differences in 5-year overall survival and local recurrence-free survival were observed among the three groups in the multivariate analysis.