The authors aimed to assess the long-term oncological impact of resection margins in patients with locally advanced rectal cancer using a comprehensive whole mount pathological section analysis. 103 patients were prospectively enrolled. All with locally advanced rectal cancer and post neoadjuvant combined modality therapy (CMT). Whole mount pathological analysis was performed and clinicopathalogical variables were correlated with disease specific survival (DSS). Sphincter preservation was achieved in 80% of patients, and the median distal margin was 2 cm (0.1 to10 cm). 22 patients (21%) had distal margins 1 cm or less and no patient had a positive distal margin. Viable distal intramural tumor spread was found in 3 patients (2.7%), limited to 1 cm or less from the gross tumor edge. At a median follow-up of 68 months, 5-year DSS was 86% and 1 patient experienced a local recurrence. Factors predictive of worse DSS included advanced tumor (T) and nodal (N) stage, tumor progression on neoadjuvant CMT, lack of a complete pathologic response, tumor location of 5 cm or less from the anal verge, and neurovascular invasion. The extent of the distal and radial margins of resection was not associated with DSS.
Annals of Surgery 2012;256(2):274–279
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