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Prognostic Significance of Circumferential Resection Margin Following Total Mesorectal Excision and Adjuvant Chemoradiotherapy in Patients with Rectal Cancer

¹ Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
² Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea

Correspondence: Address correspondence and reprint requests to: Nam Kyu Kim, MD, 134 Shincheondong, Seodaemun-ku 120-752, Seoul, South Korea; E-mail: namkyuk{at}yumc.yonsei.ac.kr

Background: This study was designed to evaluate the prognostic value of circumferential resection margin (CRM) in rectal cancer patients who underwent curative resection with adjuvant chemoradiotherapy (CRT).

Methods: We studied 504 patients who underwent total mesorectal excision with adjuvant CRT for rectal cancer between 1997 and 2001. The patients were divided into two groups: a negative CRM group (CRM > 1 mm) and a positive CRM group (CRM 1 mm). The survival rates, local recurrence rates, and systemic recurrence rates were compared between groups.

Results: The negative CRM group had 460 patients and the positive CRM group had 44 patients. The 5-year local and systemic recurrence rates were 11.3 and 25.3%, respectively, in the negative CRM group and 35.2 and 60.8% in the positive CRM group, respectively. The cancer-specific 5-year survival rates for the two groups were 72.5 and 26.9% (P < .001), respectively. CRM was found to be an independent prognostic factor by multivariate analyses which were adjusted for known outcome predictors (P < .001).

Conclusion: Oncological outcome for patients in the positive CRM group is less favorable than for those in the negative CRM group. Adjuvant CRT is not a definite treatment modality that can be used to compensate for a positive CRM following TME and adjuvant CRT in patients with TNM stage II or III rectal cancer.

Key Words: Circumferential resection margin • Total mesorectal excision • Rectal cancer • Adjuvant chemoradiotherapy

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