Circumferential Resection Margin is Associated with Distant Metastasis After Rectal Cancer Surgery : A Nation-Wide Population-Based Study Cohort
(2023) In Annals of Surgery 277(2). p.346-352- Abstract
OBJECTIVE: To evaluate circumferential resection margin (CRM) as a risk factor for distant metastasis (DM) in rectal cancer.
SUMMARY BACKGROUND DATA: The treatment of rectal cancer has evolved over the last decades. Surgical radicality is considered the most important factor in preventing recurrences including local and distant. CRM ≤1.0 mm is considered to increase recurrence risk. This study explores the risk of DM in relation to exact CRM.
METHODS: All patients treated with abdominal resection surgery for rectal cancer between 2005 and 2013 in Sweden were eligible for inclusion in this retrospective study. Primary endpoint was DM.
RESULTS: 12146 cases were identified. 8593 cases were analysed after exclusion. 717... (More)
OBJECTIVE: To evaluate circumferential resection margin (CRM) as a risk factor for distant metastasis (DM) in rectal cancer.
SUMMARY BACKGROUND DATA: The treatment of rectal cancer has evolved over the last decades. Surgical radicality is considered the most important factor in preventing recurrences including local and distant. CRM ≤1.0 mm is considered to increase recurrence risk. This study explores the risk of DM in relation to exact CRM.
METHODS: All patients treated with abdominal resection surgery for rectal cancer between 2005 and 2013 in Sweden were eligible for inclusion in this retrospective study. Primary endpoint was DM.
RESULTS: 12146 cases were identified. 8593 cases were analysed after exclusion. 717 (8.6%) patients had CRM ≤1.0 mm and 7577 (91.4%) patients CRM >1.0 mm. DM recurrence rate at 5 years was 42.1% (95% CI 32.5-50.3), 31.5% (95% CI 27.3-35.5), 25.8% (95% CI 16.2-34.4) and 19.5% (95% CI 18.5-19.5) when CRM was 0.0 mm, 0.1-1.0 mm, 1.1-1.9 mm and CRM ≥2 mm respectively. Multivariable analysis revealed higher DM risk in CRM 0.0-1.0 mm versus >1.0 mm (HR 1.28, 95% c.i. 1.06 to 1.56; P=<0.011). No significant difference in DM risk in CRM 1.1 - 1.9 mm versus ≥2.0 mm (HR 0.66, 95% c.i. 0.34 to 1.28; P=0.224) could be detected.
CONCLUSIONS: The risk of DM decreases with increasing CRM. Moreover, CRM ≤1.0 mm is a significant risk factor for DM. Thus, CRM is a dominant factor when discussing risk of DM after rectal cancer surgery.
(Less)
- author
- Agger, E LU ; Jörgren, F LU ; Lydrup, M-L LU and Buchwald, P LU
- organization
- publishing date
- 2023-02-01
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Annals of Surgery
- volume
- 277
- issue
- 2
- pages
- 346 - 352
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- pmid:34793342
- scopus:85137876923
- ISSN
- 1528-1140
- DOI
- 10.1097/SLA.0000000000005302
- language
- English
- LU publication?
- yes
- additional info
- Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
- id
- 1af3cdf9-4d7e-418c-9bfb-719b36d79b76
- date added to LUP
- 2021-12-29 11:28:40
- date last changed
- 2024-09-06 01:09:12
@article{1af3cdf9-4d7e-418c-9bfb-719b36d79b76, abstract = {{<p>OBJECTIVE: To evaluate circumferential resection margin (CRM) as a risk factor for distant metastasis (DM) in rectal cancer.</p><p>SUMMARY BACKGROUND DATA: The treatment of rectal cancer has evolved over the last decades. Surgical radicality is considered the most important factor in preventing recurrences including local and distant. CRM ≤1.0 mm is considered to increase recurrence risk. This study explores the risk of DM in relation to exact CRM.</p><p>METHODS: All patients treated with abdominal resection surgery for rectal cancer between 2005 and 2013 in Sweden were eligible for inclusion in this retrospective study. Primary endpoint was DM.</p><p>RESULTS: 12146 cases were identified. 8593 cases were analysed after exclusion. 717 (8.6%) patients had CRM ≤1.0 mm and 7577 (91.4%) patients CRM >1.0 mm. DM recurrence rate at 5 years was 42.1% (95% CI 32.5-50.3), 31.5% (95% CI 27.3-35.5), 25.8% (95% CI 16.2-34.4) and 19.5% (95% CI 18.5-19.5) when CRM was 0.0 mm, 0.1-1.0 mm, 1.1-1.9 mm and CRM ≥2 mm respectively. Multivariable analysis revealed higher DM risk in CRM 0.0-1.0 mm versus >1.0 mm (HR 1.28, 95% c.i. 1.06 to 1.56; P=<0.011). No significant difference in DM risk in CRM 1.1 - 1.9 mm versus ≥2.0 mm (HR 0.66, 95% c.i. 0.34 to 1.28; P=0.224) could be detected.</p><p>CONCLUSIONS: The risk of DM decreases with increasing CRM. Moreover, CRM ≤1.0 mm is a significant risk factor for DM. Thus, CRM is a dominant factor when discussing risk of DM after rectal cancer surgery.</p>}}, author = {{Agger, E and Jörgren, F and Lydrup, M-L and Buchwald, P}}, issn = {{1528-1140}}, language = {{eng}}, month = {{02}}, number = {{2}}, pages = {{346--352}}, publisher = {{Lippincott Williams & Wilkins}}, series = {{Annals of Surgery}}, title = {{Circumferential Resection Margin is Associated with Distant Metastasis After Rectal Cancer Surgery : A Nation-Wide Population-Based Study Cohort}}, url = {{http://dx.doi.org/10.1097/SLA.0000000000005302}}, doi = {{10.1097/SLA.0000000000005302}}, volume = {{277}}, year = {{2023}}, }