Annals of Coloproctology

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Colorectal cancer

Impact of consolidation chemotherapy in poor responders to neoadjuvant radiation therapy: magnetic resonance imaging–based clinical-radiological correlation in high-risk rectal cancers: Swapnil Patel, Suman Ankathi, Purvi Haria, Mufaddal Kazi, Ashwin L. Desouza, Avanish Saklani; Ann Coloproctol. 2023;39(6):474-483. Published online December 21, 2023; DOI: https://doi.org/10.3393/ac.2023.00080.0011

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Purpose
The current study was conducted to examine the role of consolidation chemotherapy after neoadjuvant radiation therapy (NART) in decreasing the involvement of the mesorectal fascia (MRF) in high-risk locally advanced rectal cancers (LARCs).
Methods
In total, 46 patients who received consolidation chemotherapy after NART due to persistent MRF involvement were identified from a database. A team of 2 radiologists, blinded to the clinical data, studied sequential magnetic resonance imaging (MRI) scans to assess the tumor response and then predict a surgical plan. This prediction was then correlated with the actual procedure conducted as well as histopathological details to assess the impact of consolidation chemotherapy.
Results
The comparison of MRI-based parameters of sequential images showed significant downstaging of T2 signal intensity, tumor height, MRF involvement, diffusion restriction, and N category between sequential MRIs (P < 0.05). However, clinically relevant downstaging (standardized mean difference, > 0.3) was observed for only T2 signal intensity and diffusion restriction on diffusion-weighted imaging. No clinically relevant changes occurred in the remaining parameters; thus, no change was noted in the extent of surgery predicted by MRI. Weak agreement (Cohen κ coefficient, 0.375) and correlation (Spearman rank coefficient, 0.231) were found between MRI-predicted surgery and the actual procedure performed. The comparison of MRI-based and pathological tumor response grading also showed a poor correlation.
Conclusion
Evidence is lacking regarding the use of consolidation chemotherapy in reducing MRF involvement in LARCs. The benefit of additional chemotherapy after NART in decreasing the extent of planned surgery by reducing margin involvement requires prospective research.

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Survival benefit of adjuvant chemotherapy in high-risk patients with colon cancer regardless of microsatellite instability
Sung Uk Bae, Jong Lyul Lee, Chun-Seok Yang, Eun Jung Park, Soo Yeun Park, Chang Woo Kim, Woong Bae Ji, Gyung Mo Son, Yoon Dae Han, So Hyun Kim, Min Sung Kim, Youn Young Park, Kyung Ha Lee, Chang Hyun Kim, Gi Won Ha, JaeIm Lee, Kyeong Eui Kim, Woon Kyung J
European Journal of Surgical Oncology.2025; 51(6): 109674. CrossRef
Non-operative management of locally advanced rectal cancer with an emphasis on outcomes and quality of life: a narrative review
In Ja Park
Ewha Medical Journal.2025; 48(3): e40. CrossRef
The conundrum of total neoadjuvant therapy in rectal cancer
Devesh S. Ballal, Tejas P. Vispute, Avanish P. Saklani
Colorectal Disease.2024; 26(5): 1068. CrossRef

Clinical Outcomes of Patients With Locally Advanced Rectal Cancer With Persistent Circumferential Resection Margin Invasion After Preoperative Chemoradiotherapy: Chang Hyun Kim, Seung-Seop Yeom, Hand-Duk Kwak, Soo Young Lee, Jae Kyun Ju, Young Jin Kim, Hyeong Rok Kim; Ann Coloproctol. 2019;35(2):72-82. Published online April 30, 2019; DOI: https://doi.org/10.3393/ac.2019.04.22

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Purpose
Treatment after failure of circumferential resection margin (CRM) conversion after preoperative chemoradiotherapy (pCRT) for locally advanced rectal cancer (LARC) has not been evaluated well. We conducted a single‐center, retrospective analysis to fill this information gap.
Methods
From 2008 to 2016, we included 112 patients who had predictive CRM involvement on baseline magnetic resonance imaging (MRI) and who underwent surgery following pCRT for LARC. Baseline and posttreatment radiologic and clinical factors were analyzed.
Results
Of 493 patients with LARC, 112 had CRM involvement by baseline MRI (mrCRM). In 40 patients (35.7%), mrCRM involvement was converted as negative posttreatment CRM (ymrCRM−). Multivariate analysis showed the risk factors for persistent CRM involvement (ymrCRM+) after pCRT were extramural venous invasion (mrEMVI+) (P = 0.030) and lower tumor location (P = 0.007). In addition, persistent CRM involvement after pCRT was an independent risk factor for predicting pathologic CRM involvement. The Cox proportional hazard model showed baseline positive mrEMVI remained significant for disease-free survival (DFS) (P < 0.001). On posttreatment MRI, abdominoperineal resection (P = 0.031), intersphincteric resection (P = 0.006), and persistent CRM involvement (P = 0.001) remained significant for local recurrence-free survival. With regard to DFS, persistent CRM involvement (P = 0.048) and positive EMVI on posttreatment MRI (ymrEMVI) (P = 0.014) were significant. In the patient subgroup with persistent CRM involvement, 5-year DFS in patients with mrEMVI and ymrEMVI was 29.8% and 21.2%, respectively.
Conclusion
Patients who fail to convert to negative CRM have extremely poor oncologic outcomes. Lower tumor height and negative mrEMVI status were good responders to ymrCRM conversion. Our results suggest that these patients require a more intensive treatment modality.

Citations

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Post‐diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta‐analysis
Nerea Becerra‐Tomás, Georgios Markozannes, Margarita Cariolou, Katia Balducci, Rita Vieira, Sonia Kiss, Dagfinn Aune, Darren C. Greenwood, Laure Dossus, Ellen Copson, Andrew G. Renehan, Martijn Bours, Wendy Demark‐Wahnefried, Melissa M. Hudson, Anne M. Ma
International Journal of Cancer.2024; 155(3): 400. CrossRef
A Review of Neoadjuvant Therapy and the Watch-and-Wait Protocol in Rectal Cancer: Current Evidence and Future Directions
Iulian M Slavu, Octavian Munteanu, Florin Filipoiu, Raluca Tulin, Anca Monica Macovei Oprescu , Ileana Dima, Iulian A Dogaru, Adrian Tulin
Cureus.2024;[Epub] CrossRef
A Predictive Model to Evaluate Pathologic Complete Response in Rectal Adenocarcinoma
Shuiwang Qing, Lei Gu, Tingting Du, Xiaolan Yin, Ke-jia Zhang, Huo-jun Zhang
Technology in Cancer Research & Treatment.2023;[Epub] CrossRef
Oncologic Outcomes Associated With MRI-detected Extramural Venous Invasion (mrEMVI) in Rectal Cancer
François Rouleau Fournier, Mohammad Ali K. Motamedi, Carl J. Brown, Terry Phang, Manoj J. Raval, Cameron J. Hague, Ahmer A. Karimuddin
Annals of Surgery.2022; 275(2): 303. CrossRef
Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef
Are oncological long-term outcomes equal after laproscopic completed and converted laparoscopic converted rectal resection for cancer?
M. Finochi, B. Menahem, G. Lebreton, J. Lubrano, Y. Eid, A. Alves
Techniques in Coloproctology.2021; 25(1): 91. CrossRef
Sphincter‐saving surgery for ultra‐low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long‐term follow‐up?
Philippe Rouanet, Michel Rivoire, Sophie Gourgou, Bernard Lelong, Eric Rullier, Merhdad Jafari, Laurent Mineur, Marc Pocard, Jean Luc Faucheron, François Dravet, Denis Pezet, Jean Michel Fabre, Laurent Bresler, Jacques Balosso, Christophe Taoum, Claire Le
Journal of Surgical Oncology.2021; 123(1): 299. CrossRef
The prognostic value of MRI-detected extramural vascular invasion (mrEMVI) for rectal cancer patients treated with neoadjuvant therapy: a meta-analysis
Silin Chen, Ning Li, Yuan Tang, Jinming Shi, Ying Zhao, Huiying Ma, Shulian Wang, Ye-xiong Li, Jing Jin
European Radiology.2021; 31(12): 8827. CrossRef
Predictors of Positive Circumferential Resection Margin in Rectal Cancer: A Current Audit of the National Cancer Database
Hillary L. Simon, Thais Reif de Paula, Magda M. Profeta da Luz, Ravi P. Kiran, Deborah S. Keller
Diseases of the Colon & Rectum.2021; 64(9): 1096. CrossRef
MRI-detected extramural venous invasion of rectal cancer: Multimodality performance and implications at baseline imaging and after neoadjuvant therapy
Akitoshi Inoue, Shannon P. Sheedy, Jay P. Heiken, Payam Mohammadinejad, Rondell P. Graham, Hee Eun Lee, Scott R. Kelley, Stephanie L. Hansel, David H. Bruining, Jeff L. Fidler, Joel G. Fletcher
Insights into Imaging.2021;[Epub] CrossRef
Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
Annals of Coloproctology.2021; 37(6): 351. CrossRef
Surgical Treatment of Low-Lying Rectal Cancer: Updates
Cristopher Varela, Nam Kyu Kim
Annals of Coloproctology.2021; 37(6): 395. CrossRef
Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef
Reconsideration of the Safety of Laparoscopic Rectal Surgery for Cancer
Gyung Mo Son, Bong-Hyeon Kye, Min Ki Kim, Jun-Gi Kim
Annals of Coloproctology.2019; 35(5): 229. CrossRef

Association Between a Close Distal Resection Margin and Recurrence After a Sphincter-Saving Resection for T3 Mid- or Low-Rectal Cancer Without Radiotherapy: Jae Woong Han, Min Jae Lee, Ha Kyung Park, Jae Ho Shin, Min Sung An, Tae Kwun Ha, Kwang Hee Kim, Ki Beom Bae, Tae Hyun Kim, Chang Soo Choi, Sang Hoon Oh, Min Kyung Oh, Mi Seon Kang, Kwan Hee Hong; Ann Coloproctol. 2013;29(6):231-237. Published online December 31, 2013; DOI: https://doi.org/10.3393/ac.2013.29.6.231

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Abstract PDF

Purpose

To maintain the patient's quality of life, surgeons strive to preserve the sphincter during rectal cancer surgery. This study evaluated the oncologic safety of a sphincter-saving resection with a distal resection margin (DRM) <1 cm without radiotherapy in T3, mid- or low-rectal cancer.

Methods

This retrospective study enrolled 327 patients who underwent a sphincter-saving resection for proven T3 rectal cancer located <10 cm from the anal verge and without radiotherapy between January 1995 and December 2011. The oncologic outcomes included the 5-year cancer-specific survival, the local recurrence, and the systemic recurrence rates.

Results

In groups A (DRM ≤1 cm) and B (DRM >1 cm), the 5-year cancer-specific survival rates were 81.57% and 80.03% (P = 0.8543), the 5-year local recurrence rates were 6.69% and 9.52% (P = 0.3981), and the 5-year systemic recurrence rates were 19.46% and 23.11% (P = 0.5750), respectively.

Conclusion

This study showed that the close DRM itself should not be a contraindication for a sphincter-saving resection for T3 mid- or low-rectal cancer without radiotherapy. However, a prospective randomized controlled trial including the effect of adjuvant therapy will be needed.

Citations

Citations to this article as recorded by

The Impact of Narrow and Infiltrated Distal Margin After Proctectomy for Rectal Cancer on Patients’ Outcomes: a Systematic Review and Meta-analysis
Islam H. Metwally, Mohammad Zuhdy, Omar Hamdy, Ahmed M. Fareed, Saleh S. Elbalka
Indian Journal of Surgical Oncology.2022; 13(4): 750. CrossRef
Association of levels of metabolites with the safe margin of rectal cancer surgery: a metabolomics study
Shaopeng Zhang, Guoqiang Pan, Zhifeng Liu, Yuan Kong, Daguang Wang
BMC Cancer.2022;[Epub] CrossRef
Distal resection margins in rectal cancer specimens: differences in assessment between surgeons and pathologists and the influence of neoadjuvant chemoradiation
T. L. Ghezzi, C. Tarta, P. C. Contu, A. R. Lazzaron, B. M. Contin, L. M. Kliemann, D. C. Damin
Updates in Surgery.2021; 73(5): 1787. CrossRef
Surgical margins in squamous cell carcinoma, different for the vulva?
Noortje Pleunis, Maria E.J. Leermakers, Anneke A. van der Wurff, Paul J.J.M. Klinkhamer, Nicole P.M. Ezendam, Dorry Boll, Joanne A. de Hullu, Johanna M.A. Pijnenborg
European Journal of Surgical Oncology.2018; 44(10): 1555. CrossRef
Continuous Effect of Radial Resection Margin on Recurrence and Survival in Rectal Cancer Patients Who Receive Preoperative Chemoradiation and Curative Surgery: A Multicenter Retrospective Analysis
SooYoon Sung, Sung Hwan Kim, Joo Hwan Lee, Taek Keun Nam, Songmi Jeong, Hong Seok Jang, Jin Ho Song, Jeong Won Lee, Jung Min Bae, Jong Hoon Lee
International Journal of Radiation Oncology*Biology*Physics.2017; 98(3): 647. CrossRef
Efficacy and Safety of Low-Dose-Rate Endorectal Brachytherapy as a Boost to Neoadjuvant Chemoradiation in the Treatment of Locally Advanced Distal Rectal Cancer: A Phase-II Clinical Trial
Shapour Omidvari, Shadi Zohourinia, Mansour Ansari, Leila Ghahramani, Mohammad Zare-Bandamiri, Ahmad Mosalaei, Niloofar Ahmadloo, Saeedeh Pourahmad, Hamid Nasrolahi, Sayed Hasan Hamedi, Mohammad Mohammadianpanah
Annals of Coloproctology.2015; 31(4): 123. CrossRef
Safe Distal Resection Margin in Patients With T3 Mid and Distal Rectal Cancer Who Underwent a Sphincter-Saving Resection Without Preoperative Radiotherapy
Bong Hwa Lee, Hyoung Chul Park, Min Jeong Kin, Mi Young Jang
Annals of Coloproctology.2013; 29(6): 219. CrossRef

Value and Interpretation of Resection Margin after a Colonoscopic Polypectomy for Malignant Polyps: Eun Jung Jang, Dae Dong Kim, Chang Ho Cho; J Korean Soc Coloproctol. 2011;27(4):194-201. Published online August 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.4.194

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Abstract PDF

Purpose

This study was designed to compare the clinicopathologic findings of an endoscopic polypectomy for malignant polyps with subsequent surgery and to evaluate the appropriateness of the pathologic finding criterion of the resection margin as an indicator for surgery in cases of malignant colorectal polyps.

Methods

We examined the clinicopathologic characteristics, complications and prognoses among the patients who underwent a colonoscopic polypectomy in both our hospitals and at other hospitals from April 2003 and April 2010. These patients were divided into two groups, the group (non-operation group) that only underwent a polypectomy (n = 37) and the group (operation group) that underwent a polypectomy with subsequent surgery (n = 33).

Results

There were no differences between two groups in the ratios of the number of men to the number of women, the ages or the comorbidities. In terms of endoscopic findings, we found no differences between the two groups in the locations of the polyps, the sizes of the polyps, or the presence of stalks. However, ulceration of polyps was higher in the non-operation group (51.5% vs. 21.6%; P = 0.009), as was the case with submucosal invasion (75.8% vs. 16.2%; P < 0.005). When an endoscopic polypectomy was performed, incomplete resection margins and specimens with margins involved occurred more frequently in the operation group (93.9% vs. 51.4%; P < 0.005), but no residual tumor was detected in 31 of 33 (93.9%) patients in that group. One pathologist reviewed the specimens of 54 patients (operation group, 19; non-operation group, 36). Six of the 19 polyps (31.6%) in the operation group and fifteen of the 36 polyps (41.7%) in the non-operation group had a margin without cancer cells.

Conclusion

We may accept the criterion of a safe margin, including a coagulation zone. A multidisciplinary approach has to be developed by surgeons, endoscopists and pathologists based on a discussion of the risk factors for the patient before making a decision on the treatment treatment.

Citations

Citations to this article as recorded by

Frequency and clinicopathological correlation of gastrointestinal polyps: A six-year single center experience
Goran Mohammed Raouf Abdulqader
Open Medicine.2024;[Epub] CrossRef
Factors Predicting Malignant Occurrence and Polyp Recurrence after the Endoscopic Resection of Large Colorectal Polyps: A Single Center Experience
Olga Mandic, Igor Jovanovic, Mirjana Cvetkovic, Jasmina Maksimovic, Tijana Radonjic, Maja Popovic, Novica Nikolic, Marija Brankovic
Medicina.2022; 58(10): 1440. CrossRef
Near-infrared photoimmunotherapy is effective treatment for colorectal cancer in orthotopic nude-mouse models
Hannah M. Hollandsworth, Siamak Amirfakhri, Filemoni Filemoni, Justin Molnar, Robert M. Hoffman, Paul Yazaki, Michael Bouvet, Irina V. Lebedeva
PLOS ONE.2020; 15(6): e0234643. CrossRef
Surgical treatment of malignant colon polyps
Nuno Telo Preto Ramos, André Gonçalves, Pedro Correia da Silva, José Barbosa
Journal of Coloproctology.2018; 38(04): 260. CrossRef

Prognostic Analysis According to N Stage and Circumferential Resection Margin in Patients with Locally Advanced Rectal Cancer.: Sohn, Yong Ki , Shin, Jin Yong , Hong, Kwan Hee; J Korean Soc Coloproctol. 2010;26(3):217-224.; DOI: https://doi.org/10.3393/jksc.2010.26.3.217

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Abstract PDF: PURPOSE
Efforts must be made to clarify the contribution of lymph node metastasis (NM) to adjuvant (chemo) radiotherapy following a curative resection for rectal cancer as the circumferential resection margin (CRM) has increasingly become a more reliable prognosticator for rectal cancer. This study examined the prognostic impact of NM on local recurrence, disease-free survival. and overall survival rates in curatively resected patients with locally advanced rectal cancer.
METHODS
Two hundred two patients with locally advanced rectal cancer curatively resected in Pusan Paik Hospital from January 1995 to December 2003 were enrolled. These patients were divided into three groups according to lymph node (N) disease (N0: node negative, n=79; N1: 1-3 nodes positive, n=70; N2: > or =4 nodes positive, n=53). The potential prognostic factors, for example, T and N stage, preoperative carcinoembryonic antigen (CEA), postoperative (chemo) radiotherapy, operative methods, and several pathologic variables, were assessed among the three groups. The potential clinicopathologic factors were analyzed by using the Kaplan-Meier method, and the prognostic factors were compared in a Cox regression model. Also, we compared the oncologic results of 26 patients with a positive CRM (CMI) with those of the N1 and the N2 subgroups.
RESULTS
N2 patients had an impaired 5-yr local control rate (19.1%) compared with N0 (6.8%) and N1 (11.6%, P=0.029) patients after a median follow up of 60 months (range, 6 to 156 mo). Differences in disease-free and overall survival were also significantly different statistically among the three groups (84.0% and 85.2% for N0; 54.9% and 65.1% for N1; 37.3% and 49.8% for N2; P<0.001 both). The impact of NM on the local recurrence, disease-free survival and overall survival was confirmed in the regression model for the curatively resected patients. There were no significant differences in the recurrence and the survival rates between CMI and N2 stage.
CONCLUSION
NM has an independent prognostic impact on local failure and on disease-free survival and overall survival. Based on these findings, NM should be considered as an indicatior for adjuvant therapy. Although the prognostic impact of CMI is similar to that of N2, a larger prospective study is needed to clarify the prognostic association of CMI and N2.

Abdominoperineal Resection in the Treatment of Locally-advanced Low Rectal Cancer: Is Preoperative Chemoradiation Advantageous?.: Kim, Jeong Yeon , Kim, Jin Soo , Kim, Young Wan , Hur, Hyuk , Min, Byung Soh , Kim, Nam Kyu; J Korean Soc Coloproctol. 2010;26(2):129-136.; DOI: https://doi.org/10.3393/jksc.2010.26.2.129

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Abstract PDF: PURPOSE
An abdominoperineal resection (APR) has a poor prognosis. However, limited studies about the prognostic factors in APR and the role of preoperative chemoradiotherapy (CRT) have been performed even though in rectal cancer, the application of preoperative CRT provides better local control compared to postoperative CRT. The aim of this study was to identify the prognostic factors and the impact of preoperative CRT in patients who undergo an APR.
METHODS
A retrospective analysis was conducted with a total of 133 patients who underwent an APR, cT3, cT4, or cN(+) patients, for rectal cancer between January 1995 and October 2004. Fifty-one patients treated with preoperative CRT (Group 1) were compared with 82 APR patients treated with postoperative CRT (Group 2). Oncologic outcomes were compared between the two groups, and the clinicopathologic factors affecting the treatment outcomes were evaluated.
RESULTS
The median follow-up period was 61.2 mo (range 6 to 194 mo). Circumferential margin (CRM) involvement was significantly associated with local recurrence (LR) and with disease-free survival in APR patients (P<0.001, P=0.011). The 5-yr LR rate was significantly lower in Group 1 than in Group 2 (P=0.013) in the univariate analysis, but no difference was noted in multivariate analysis (P=0.315). In Group 1, CRM involvement, tumor size, and lymph node metastasis were significantly lower than they were in Group 2 (P=0.043, P=0.003, P<0.001).
CONCLUSION
For achieving adequate oncologic outcomes in APR patients, an adequate CRM should be acquired with an optimal operation. In addition, preoperative CRT would be helpful for high-risk APR patients with a threatening CRM margin, providing the benefit of tumor downstaging.

Prognostic Significance of the Circumferential Resection Margin in Invasive T3 Rectal Cancer.: Joo, In Ho , Jin, Sang Hwa , Bae, Ki Beom , Shin, Jin Yong , Choi, Chang Soo , Choi, Su Im , Hong, Kwan Hee; J Korean Soc Coloproctol. 2008;24(4):278-286.; DOI: https://doi.org/10.3393/jksc.2008.24.4.278

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Abstract PDF

PURPOSE
Because depth of invasion by T3 rectal cancer can vary according to the extent of mesorectal invasion, the prognosis for invasive T3 rectal cancer is reported to be very different from that for minimal invasive cancer. Recently, with more emphasis on circumferential resection margin (CRM) status, the T stage, rather than the N stage, seems to be a more valuable prognostic marker in rectal cancer. Therefore, the aim of this study is to determine the prognostic significance of the CRM in invasive T3 rectal cancer.
METHODS
Through reviewing 324 consecutive patients with rectal cancer who underwent a curative resection between January 1995 and December 2002 at Busan Paik hospital, 195 patients with invasive T3 rectal cancer, who had not received preoperative neoadjuvant therapy were selected. The patients were classified into a negative CRM group (negative group, n=173) or a positive CRM group (positive group, n=22), and the patients were subgrouped according to the presence of lymph-node (LN) metastasis and CRM status as negative LN and negative CRM (L-/CM-), negative LN and positive CRM (L-/CM+), positive LN and negative CRM (L+/CM-) and positive LN and positive CRM (L+/CM+). All pathological specimens were re-reviewed by a single pathologist, and the distance between the most advanced edge and the outermost aspect of the specimen was re-measured by using a microscope. Local relapse rates, disease free survival, and overall survival were compared using the Kaplan- Meier method. Multivariate analyses to identify independent prognostic factors were performed using the logistic regression model.
RESULTS
Local recurrence rates in the positive group and the negative group were 38.6% and 15.3%, respectively (P=0.004, log-rank test). The multiple logistic regression model demonstrated positive CRM (hazard ratio 4.4, P=0.0007) and N2 nodal status (hazard ratio 2.4, P=0.02) as predictors of local recurrence. In the subgroup analysis, the overall recurrence rates and survival rates were, respectively, 12.3% and 86.5% in the L-/CM- subgroup, 53.1% and 50.3% in the L-/CM+ subgroup, 52.7% and 50.0% in the L+/ CM- subgroup, and 58.7 % and 33.8% in the L+/CM+ subgroup (log rank test for trend; P=0.0001 and P=0.0001, respectively).
CONCLUSIONS
In the event of predicted CRM involvement in invasive T3 rectal cancer, adjuvant therapy should be performed to improve local control. Also, larger prospective studies are needed to clarify the prognostic role of the CRM in invasive T3 rectal cancer because the number of cases in this study was small, especially in the number of CRM positive cases.

Citations

Citations to this article as recorded by

Comparison of short-term oncologic outcomes following laparoscopic versus conventional open surgery for rectal cancer
Nak Jun Choi, Jong Han Yoo, Hong Tae Lee, Jae Ho Shin, Ha Kyoung Park, Min Sung An, Tae Kwun Ha, Kwang Hee Kim, Ki Beom Bae, Tae Hyun Kim, Chang Soo Choi, Sang Hoon Oh, Minkyung Oh, Kwan Hee Hong
Korean Journal of Clinical Oncology.2013; 9(1): 17. CrossRef

Outcomes after a Hepatic Resection for Multiple Hepatic Metastases from Colorectal Cancer.: Choi, Pyong Wha , Kim, Hee Cheol , Jung, Sang Hun , Kim, Dae Dong , Park, In Ja , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2008;24(2):100-106.; DOI: https://doi.org/10.3393/jksc.2008.24.2.100

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PURPOSE
Surgical resection is still considered as the gold standard in patients with hepatic metastases from colorectal cancer. The impact of the number of hepatic metastases is a controversial issue. We aimed to evaluate the outcomes and the prognostic factors after hepatic resection in multiple hepatic metastases from colorectal cancer. METHODS: Between June 1989 and October 2005, 42 patients underwent hepatic resections for three or more hepatic metastases from colorectal cancer. Disease-free survival analyses were performed on patients grouped as a function of the following factors: age, sex, preoperative serum CEA level, primary tumor site, nodal status, intrahepatic distribution, diameter of the liver lesion, their number, and the resection margin. RESULTS: Of the 42 patients, 29 (69.0%) developed recurrence (16 in the liver alone, 5 in the liver and another distant site, 8 in a distant site alone) during a median follow-up of 24 months. The overall 1-, 2-, and 5-year survival rates were 89.1%, 58.6%, and 31.8%, respectively. The 1-year and 2-year disease-free survival rates were 38.1 and 29.4%, respectively. There was no postoperative mortality and the morbidity rate was 11.9%. The disease-free survival rate was independently associated with the resection margin of the metastatic tumor (P=0.017). The 1-year disease- free survival rates in patients with more than a 5-mm resection margin and with less than a 5-mm resection margin were 72.7%, and 25.8%, respectively.
CONCLUSIONS
If technically feasible, an aggressive hepatic resection should be performed for the treatment of multiple hepatic metastases from colorectal cancer. The surgical resection margin may govern the outcomes in patients with surgically curable hepatic metastases from colorectal cancer.

Citations

Citations to this article as recorded by

Scoring of prognostic factors that influence long-term survival in patients with hepatic metastasis of colorectal cancer
Sung Woo Ahn, Ahn Soo Na, Jae Do Yang, Hong Pil Hwang, Hee Chul Yu, Baik Hwan Cho
Korean Journal of Hepato-Biliary-Pancreatic Surgery.2011; 15(3): 146. CrossRef
Impact of Resection for Primary Colorectal Cancer on Outcomes in Patients with Synchronous Colorectal Liver Metastases
Jung Wook Huh, Chol Kyoon Cho, Hyeong Rok Kim, Young Jin Kim
Journal of Gastrointestinal Surgery.2010; 14(8): 1258. CrossRef

Clinical Significance of Lateral Resection Margin Involvement for Colon Cancer.: Lee, Nan Joo , Ha, Tae Geun , Shin, Jin Yong , Jeong, Su Jin , Hong, Kwan Hee; J Korean Soc Coloproctol. 2006;22(5):322-329.

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Abstract PDF: PURPOSE
The clinical significance of the lateral resection margin for rectal cancer has been widely investigated. The ascending and the descending colon do not have a peritoneal covering posteriorly. Therefore, colon cancers located on their posterior side can penetrate the entire bowel wall, which is similar to mesorectal invasion in rectal cancer. However, the prognostic significance of the retroperitoneal resection margin involvement is unknown. The aim of this study is to evaluate the prognostic significance of the lateral resection margin in ascending and descending colon cancer.
METHODS
A retrospective study was performed and involved 92 patients who had undergone a curative resection for right or left colon cancer with TNM stage II and III. The patients were assigned to either a lateral margin negative group (LMNG, n=73) or a lateral margin positive group (LMPG, n=19) according to the presence of a tumor or a metastatic lymph node within 1 mm of the lateral resection margin. The oncological outcomes of the LMPG were compared with those of the LMNG.
RESULTS
The LMPG was younger and had higher incidences of tumors positive vascular or neural invasion and advanced T and N stages. The overall recurrence rate of the LMPG was higher than that of the LMNG (36.8% versus 16.4%) and the cumulative survival rate of the LMPG was significantly lower than that of the LMNG (35.0% versus 76.2%). High preoperative CEA, lymphatic invasion, lateral margin involvement of the tumor, N2 in nodal status were significant factors in the univariate analysis for evaluation of the prognosis, but lateral margin involvement was not a significant factor in the multivariate analysis. In the lymph-node-positive group and the CEA non-elevation group, lateral margin involvement of the tumor was revealed as a prognostic factor.
CONCLUSIONS
Lateral margin involvement of ascending and descending colon cancer affects tumor recurrence and overall survival, but it is not a significant prognostic factor.

Prognostic Significance of Circumferential Resection Margin following a Total Mesorectal Excision in Rectal Cancer.: Baik, Seung Hyuk , Kim, Nam Kyu , Lee, Kang Young , Sohn, Seung Kook , Cho, Chang Hwan , Kim, Ho guen , Rha, Sun Young , Chung, Hyun Cheol; J Korean Soc Coloproctol. 2005;21(5):307-313.

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Abstract PDF: PURPOSE
Studies of the circumferential resection margin (CRM) in rectal cancer surgery have revealed that inadequate surgical excision correlates with a high risk of recurrence. This study was designed to evaluate the prognostic value of the CRM in rectal cancer.
METHODS
All 504 patients who underwent a total mesorectal excision for rectal cancer between 1997 and 2001 were studied. The distance between the CRM and the tumor on pathology slides (HE stain, x 20 times) was measured. The CRM was stained by using the Davidson marking system(R) (Bradley Product, Inc. USA), and a micrometer was used for the measurement. We divided the patients into a negative CRM group (CRM >3 mm), an abutting CRM group (CRM < or =3 mm without involvement), and a positive CRM group (CRM was in the tumor), and compared the oncologic results among the groups.
RESULTS
The numbers of patients in the negative CRM, the abutting CRM, and the positive CRM groups were 452, 18, and 34 respectively. The mean follow- up durations were 45.1 months (range, 1.1~88.7), 41.9 months (range, 10.7~75.2), and 33.0 months (range, 4.8~83.4), respectively. The Aslter-Coller stages of all patients were from B2 to C3. The local recurrence rate, the systemic recurrence rate, and the combined recurrence rate were, respectively, 5.5%, 17.3%, and 3.8% in the negative CRM group (>3 mm), 5.6%, 38.9%, and 5.6% in the abutting CRM group, and 8.8%, 44.1%, and 8.8% in the positive CRM group. The five-year survival rates for the negative CRM, the abutted CRM and the positive CRM groups were 73.3%, 48.4%, and 25.5% (P<0.001), respectively, and the disease-free 5-year survival rates were 63.1%, 30.6%, 24.0% (P<0.001). The CRM was shown to be an independent prognostic factor by multivariate analyses adjusted for known predictors of outcome (P<0.001).
CONCLUSIONS
The prognosis for a member of the abutting or the positive CRM group was more unfavorable than it was for a member of the negative CRM group; therefore, measurement of the CRM should be reported in the pathologic report. For patients with an abutting or a positive CRM, neoadjuvant or adjuvant chemoradiotherapy should be considered for better oncologic outcomes.

Prognostic Factors after Hepatic Resection for Metastatic Colorectal Cancer.: Kim, Hee Cheol , Kim, Chang Nam , Hong, Hyoun Kee , Lee, Dong Hee , Yu, Chang Sik , Lee, Je Hwan , Kim, Tae Won , Kim, Jin Cheon; J Korean Soc Coloproctol. 2000;16(2):87-92.

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Abstract PDF: Metastases to the liver from carcinoma of the colon and rectum occur as many as 80% of cases. As resection of metastases is proven to enhance survival and to reduce hepatic recurrence, the criteria for selection of patients and surgery type appear to be indispensable. Purpose: The aim of this study was to assess the prognostic factors after hepatic resection for metastatic colorectal cancer and propose the optimal surgical principles for resection of metastatic colorectal cancer. Methods: Sixty-three patients who underwent initial hepatic resection for liver metastases from colorectal cancer between 1989 and 1998 were analyzed regarding clinical and pathologic parameters. Results: Overall 5-year survival rate was 32%. Preoperative serum CEA level and resection margin of metastatic tumors were found to be significant predictors for poor long-term outcome. Resection margin of greater than 5 mm was closely associated with better survival. In multivariate analysis, resection margin alone was an independent prognostic factor.
Conclusions
Preoperative serum CEA level and surgical resection margin may affect the outcome for the patients who underwent hepatic resection for metastatic colorectal cancer. Surgical resection margin must be kept enough to avoid re-recurrence or metastasis during hepatic resection for metastatic colorectal cancer.

Is Laparoscopic Procedure Adequate for Colorectal Cancer Surgery?.: Kim, Jae Hwang , Huh, Jin Myeung , Yoon, Sung Su , Kim, Sang Woon , Shim, Min chul , Kwun, Koing Bo; J Korean Soc Coloproctol. 1999;15(5):434-442.

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Abstract PDF: PURPOSE
To evaluate the possibility that laparoscopic procedure could perform surgeries keeping the principle of oncologic surgery.
METHODS
From July 1993 to June 1996, thrity patients undergone laparoscopic assisted colon and rectal resections (LR) for malignant disease at Yeungman university hospital. Margins of resection and lymph nodes (LNs) recovered were compared with those of thirty stage matched open resection cases (OR, n=30) retrospectively. There was no operative mortality in both group. Operative techniques used in LR vs OR were colectomy, 5:6; anterior resection, 6:5; low anterior resection, 11:12 and abdominoperineal resection, 8:7. Parameters were analgesic use, duration of postoperative ileus, operative time, hospital stay, margins of rescetion, lymph node yield (LNs), and recurrence.
RESULTS
Patients who underwent LR had less pain, a shorter period of postoperative ileus and hospital stay than patients who underwent OR. But, the length of operative time was greater for patients undergoing LR. Mean lymph node yield in the laparoscopic group was 16 compared with 18.1 in the open group (P=0.560). Average margins of resection in LR vs OR were 13.9 cm vs 14.1 cm proximally (P=0.823), 3.6 cm vs 5.2 cm distally (P=0.498). In no case did the margins contain tumor. There was no statistical significance in dissected LNs and the length of both resection margins in both groups. Recurrence was similar in both groups.
CONCLUSIONS
In this study, there is no evidence that laparoscopic technique is inadequate in following the cancer surgery principle.

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