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From the Departments of Surgery (HGM, PP, DW, JGG, AMC), Epidemiology and Biostatistics (ER), Radiation Oncology (BDM), and Medicine (LS), Memorial Sloan-Kettering Cancer Center, New York, New York.
Correspondence: Address correspondence and reprint requests to: Jose G. Guillem, MD, MPH, 1275 York Ave., Room C-1077, New York, NY 10021; Fax: 646-422-2318; E-mail: guillemj{at}mskcc.org
Background: Preoperative combined-modality therapy (CMT) for rectal cancer allows a sphincter-sparing procedure in some individuals who would otherwise require an abdominoperineal resection. To further define the subset of rectal cancer patients suitable for this approach, we determined the adequacy of a distal margin of 
1 cm in patients with locally advanced rectal cancer requiring preoperative CMT.
Methods: Ninety-four consecutive patients, status post curative low anterior resection for rectal cancer after preoperative CMT, were identified from the prospective Colorectal Service Database. Distal margin length, tumor grade, tumor-node-metastasis stage, presence of lymphovascular and perineural invasion, and tumor distance from the anal verge were examined for their effect on recurrence and survival. Median follow-up was 44 months.
Results: Distal margin length ranged from .1 to 9.5 cm (median, 2.0 cm) and did not correlate with local recurrence (hazard ratio, 1.1; P = .34) or recurrence-free survival (hazard ratio, 1.1; P = .29) by univariate analysis. Kaplan-Meier estimates of recurrence-free survival and local recurrence at 3 years for the 1 cm versus >1 cm and the 2 cm versus >2 cm groups were not significantly different. Groups were well matched for other clinicopathologic variables.
Conclusions: Our data suggest that for patients with locally advanced rectal cancer undergoing resection and preoperative CMT, distal margins 1 cm do not seem to compromise oncological outcome.
Key Words: Rectal cancer • Distal margin • Combined-modality therapy • Total mesorectal excision
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