The influence of the distal resection margin length on local recurrence and long- term survival in patients with rectal cancer after chemoradiotherapy and sphincter- preserving rectal resection
Article Category: Research Articles
Publicado en línea: 24 may 2016
Páginas: 169 - 177
Recibido: 20 feb 2016
Aceptado: 10 abr 2016
DOI: https://doi.org/10.1515/raon-2016-0030
Palabras clave
© 2017 Jan Grosek, Vaneja Velenik, Ibrahim Edhemovic, Mirko Omejc
This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Clinicopathological features of patients according to distal resection margin (DRM)
| Group I (n = 27) | Group II (n = 31) | Group III (n = 51) | All (n = 109) | p | |
|---|---|---|---|---|---|
| Male gender | 21 (77.8) | 21 (67.7) | 33 (64.7) | 75 (68.8) | 0.490 |
| Age (years) | 60 (44–83) | 64 (37–76) | 66 (34–82) | 63 (34–83) | 0.453 |
| Length of hospitalisation (days) | 10 (7–52) | 9 (5–31) | 9 (3–36) | 9 (3–52) | 0.189 |
| Median distance from anal verge to tumor (cm) | 5 | 6 | 8 | 8 | 0.002 |
| DRM (mm) DRM = distal resection margin; Group I, DRM < 8mm; Group II, 8 ≤ DRM ≤ 20 mm; Group III, DRM > 20 mm | 5 (1–8) | 15 (9–20) | 40 (25–80) | 20 (1–80) | < 0.001 |
| CRM (mm) CRM = circumferential resection margin. | 10 (1–25) | 10 (4–30) | 10 (2–40) | 10 (1–40) | 0.284 |
| Ileostomy / Transversostomy | 22 (81.5) | 21 (67.7) | 35 (68.6) | 78 (71.6) | 0.509 |
| Surgical complications | 2 (7.4) | 5 (16.1) | 1 (2) | 8 (7.3) | 0.058 |
| T | 0.103 | ||||
| 1 | 0 (0) | 0 (0) | 1 (2) | 1 (0.9) | |
| 2 | 1 (3.7) | 4 (12.9) | 1 (2) | 6 (5.5) | |
| 3 | 26 (96.3) | 26 (83.9) | 42 (82.4) | 94 (86.2) | |
| 4 | 0 (0) | 1 (3.2) | 5 (9.8) | 6 (5.5) | |
| Missing data | 0 (0) | 0 (0) | 2 (3.9) | 2 (1.8) | |
| N | 0.047 | ||||
| 0 | 14 (51.9) | 12 (38.7) | 9 (17.6) | 35 (32.1) | |
| 1 | 8 (29.6) | 15 (48.4) | 24 (47.1) | 47 (43.1) | |
| 2 | 4 (14.8) | 4 (12.9) | 15 (29.4) | 22 (20.2) | |
| Missing data | 1 (3.7) | 0 (0) | 3 (5.9) | 4 (3.7) | |
| yT yT, yN = stage as assessed by pathologic examination of the surgical specimen (after CRT and resection) | 0.039 | ||||
| 0 | 3 (11.1) | 4 (12.9) | 3 (5.9) | 10 (9.2) | |
| 1 | 5 (18.5) | 7 (22.6) | 2 (3.9) | 14 (12.8) | |
| 2 | 7 (25.9) | 10 (32.3) | 13 (25.5) | 30 (27.5) | |
| 3 | 12 (44.4) | 9 (29) | 33 (64.7) | 54 (49.5) | |
| 4 | 0 (0) | 1 (3.2) | 0 (0) | 1 (0.9) | |
| yN yT, yN = stage as assessed by pathologic examination of the surgical specimen (after CRT and resection) | 0.004 | ||||
| 0 | 22 (81.5) | 27 (87.1) | 26 (51) | 75 (68.8) | |
| 1 | 3 (11.1) | 3 (9.7) | 17 (33.3) | 23 (21.1) | |
| 2 | 2 (7.4) | 1 (3.2) | 8 (15.7) | 11 (10.1) | |
| Regression level | 0.003 | ||||
| 1 | 0 (0) | 4 (20) | 14 (35.9) | 18 (23.7) | |
| 2 | 8 (47.1) | 5 (25) | 18 (46.2) | 31 (40.8) | |
| 3 | 6 (35.3) | 6 (30) | 4 (10.3) | 16 (21.1) | |
| 4 | 3 (17.6) | 5 (25) | 3 (7.7) | 11 (14.5) | |
| Vascular invasion | 1 (8.3) | 4 (21.1) | 4 (10.3) | 9 (12.9) | 0.477 |
| Perineural invasion | 0 (0) | 1 (5.6) | 4 (10) | 5 (7.2) | 0.342 |
| Positive lymph nodes | 5 (18.5) | 4 (12.9) | 25 (49) | 34 (31.2) | 0.001 |
Risk factors for time to death using multiple Cox regression analysis
| Variable (reference group) | Overall survival | |
|---|---|---|
| Hazard Ratio (95% CI) | P-value | |
| yT yT, yN = stage as assessed by pathologic examination of the surgical specimen (after CRT and resection) | 0.014 | |
| 1 (0) | 0.2 (0; 2.3) | 0.212 |
| 2 (0) | 0.3 (0.1; 1.5) | 0.158 |
| 3 (0) | 0.5 (0.1; 1.9) | 0.309 |
| 4 (0) | 23.1 (1.8; 302.3) | 0.017 |
| yN yT, yN = stage as assessed by pathologic examination of the surgical specimen (after CRT and resection) | 0.034 | |
| 1 (0) | 1.5 (0.4; 5.4) | 0.489 |
| 2 (0) | 4.2 (1.4; 12.6) | 0.011 |
| DRM DRM = distal resection margin; Group I, DRM < 8mm; Group II, 8 ≤ DRM ≤ 20 mm; Group III, DRM > 20 mm | 0.871 | |
| DRM Group II ( Group I) | 1.3 (0.3; 5.1) | 0.690 |
| DRM Group III (Group I) | 1.4 (0.4; 4.4) | 0.609 |
Risk factors for time to local recurrence or death using univariate Cox regression analysis
| Local recurrence-free survival | Overall survival | |||||
|---|---|---|---|---|---|---|
| Variable (reference group) | Hazard Ratio (95 % CI) | P-value | Hazard Ratio (95 % CI) | P-value | ||
| Female gender (male) | 2.3 (0.3; 16.2) | 0.411 | 0.6 (0.2; 1.6) | 0.279 | ||
| Age (years) | 1.1 (0.9; 1.2) | 0.395 | 1 (1; 1.1) | 0.125 | ||
| Length of hospitalisation (days) | 1.0 (0.8; 1.2) | 0.762 | 1 (1; 1.1) | 0.812 | ||
| DRM (mm) DRM = distal resection margin; Group I, DRM < 8 mm; Group II, 8 ≤ DRM ≤ 20 mm; Group III, DRM > 20 mm | 1 (1; 1.1) | 0.218 | 1 (1; 1) | 0.838 | ||
| DRM Group III (Group I + Group II) DRM = distal resection margin; Group I, DRM < 8 mm; Group II, 8 ≤ DRM ≤ 20 mm; Group III, DRM > 20 mm | 3.5 (0.4; 33.8) | 0.276 | 1.4 (0.6; 3.3) | 0.402 | ||
| DRM DRM = distal resection margin; Group I, DRM < 8 mm; Group II, 8 ≤ DRM ≤ 20 mm; Group III, DRM > 20 mm | 0.667 | |||||
| DRM Group II ( Group I) DRM = distal resection margin; Group I, DRM < 8 mm; Group II, 8 ≤ DRM ≤ 20 mm; Group III, DRM > 20 mm | – | – | 1.3 (0.4; 4.5) | 0.714 | ||
| DRM Group III (Group I) | – | – | 1.6 (0.5; 5.1) | 0.392 | ||
| CRM (mm) CRM = circumferential resection margin. | 1 (0.9; 1.2) | 0.524 | 1 (0.9; 1) | 0.343 | ||
| N 2 - 3 (0 - 1) | 3.6 (0.5; 25.6) | 0.199 | 1.7 (0.6; 4.4) | 0.293 | ||
| yT 0 - 1 (2 - 4) yT, yN = stage as assessed by pathologic examination of the surgical specimen (after CRT and resection) | 3.1 (0.3; 29.4) | 0.333 | 1.2 (0.4; 3.7) | 0.699 | ||
| yT yT, yN = stage as assessed by pathologic examination of the surgical specimen (after CRT and resection) | – | – | 0.017 | |||
| 1 (0) | – | – | 0.2 (0; 1.8) | 0.15 | ||
| 2 (0) | – | – | 0.4 (0.1; 1.7) | 0.215 | ||
| 3 (0) | – | – | 0.7 (0.2; 2.3) | 0.517 | ||
| 4 (0) | – | – | 19.5 (1.6; 234.6) | 0.019 | ||
| yN 0 (1-2) yT, yN = stage as assessed by pathologic examination of the surgical specimen (after CRT and resection) | 7 (0.7; 67.2) | 0.092 | 2.4 (1.1; 5.6) | 0.040 | ||
| yN yT, yN = stage as assessed by pathologic examination of the surgical specimen (after CRT and resection) | – | – | 0.020 | |||
| 1 (0) | – | – | 1.6 (0.6; 4.6) | 0.382 | ||
| 2 (0) | – | – | 4.1 (1.5; 11.2) | 0.005 | ||
| Vascular invasion | 2.4 (0.3; 23.4) | 0.441 | 0.9 (0.2; 4) | 0.892 | ||
| Perineural invasion | 6.5 (0.7; 62.8) | 0.105 | 0.9 (0.1; 6.9) | 0.920 | ||