Distal margin requirements after preoperative chemoradiotherapy for distal rectal carcinomas: areor = 1 cm distal margins sufficient?
| Autor: | Mark P. Bryer, David M. Ota, Brent W. Miedema, Boris W. Kuvshinoff, John D. Wilkes, Steven Westgate, Irfan Maghfoor |
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| Rok vydání: | 2001 |
| Předmět: |
Adult
Male medicine.medical_specialty Colorectal cancer medicine.medical_treatment Adenocarcinoma medicine Humans In patient Neoadjuvant therapy Aged Neoplasm Staging Aged 80 and over Preoperative chemoradiotherapy integumentary system Abdominoperineal resection business.industry Local failure Middle Aged medicine.disease Prognosis Distal margin Neoadjuvant Therapy Surgery Radiation therapy Oncology Feasibility Studies Lymph Node Excision Female Neoplasm Recurrence Local business Colorectal Neoplasms |
| Zdroj: | Annals of surgical oncology. 8(2) |
| ISSN: | 1068-9265 |
| Popis: | Sphincter-sparing alternatives to abdominoperineal resection (APR) in the treatment of rectal cancer often are underused out of concern for inadequate distal margins and local failure. The present study addresses whether sphincter-sparing techniques with distal marginsor = 1 cm adversely influence oncological outcome in patients given preoperative chemoradiotherapy.Thirty-seven patients with rectal canceror = 8 cm from the anal verge were enrolled in the study. Preoperative external beam radiotherapy (5400 Gy) was administered together with continuous infusion of 5-fluorouracil (300 mg/m2/day). Surgical resection was performed in 36 patients with pathological assessment of tumor response and margins. Patients with sphincter-sparing resection and distal margins1 cm oror = 1 cm and those who underwent APR were compared.Thirty-six patients completed preoperative chemoradiotherapy, with successful sphincter-preservation in 28 patients. At a median follow-up of 33 months, there were 12 recurrences overall, which included 11 distant failures and four pelvic failures. Disease-free survival (DFS) was not different between those who had an APR compared with sphincter-sparing resection with distal marginsor = 1 cm. DFS was worse (P.02) when radial margins wereor = 3 mm compared with3 mm.Sphincter preservation is feasible in more than 75% of patients with tumorsor = 8 cm from the anal verge after preoperative chemoradiotherapy. Sphincter-sparing surgery with distal marginsor = 1 cm can be used without adversely influencing local recurrence or DFS. Limited radial margins (or = 3 mm), however, are associated with increased disease recurrence. |
| Databáze: | OpenAIRE |
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