Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Circumferential Resection Margin is Associated with Distant Metastasis After Rectal Cancer Surgery : A Nation-Wide Population-Based Study Cohort

Agger, E LU orcid ; Jörgren, F LU ; Lydrup, M-L LU and Buchwald, P LU (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)
Please use this url to cite or link to this publication:
author
; ; and
organization
publishing date
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
  • scopus:85137876923
  • pmid:34793342
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
2024-06-14 19:36:49
@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 &gt;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 &gt;1.0 mm (HR 1.28, 95% c.i. 1.06 to 1.56; P=&lt;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}},
}