Impact of distal resection margin on survival after tumour-specific mesorectal excision for rectal cancer: retrospective cohort study

IF 2.7 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer Pub Date : 2025-12-01 Epub Date: 2025-08-20 DOI:10.1016/j.clcc.2025.08.001

Fabio Carbone , Roberto Santalucia , Simona Borin , Davide Ciardiello , Luca Bottiglieri , Stefano de Pascale , Emilio Bertani , Uberto Fumagalli Romario

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引用次数: 0

Abstract

Background

The safe oncological distal resection margin (DRM) after anterior resection (AR) with tumour-specific mesorectal excision (TSME) for rectal cancer is still debated. This study aims to clarify the impact of DRM on survival outcomes.

Methods

Patients who underwent an intention-to-treat AR-TSME for a non-metastatic rectal adenocarcinoma within 15 cm from the anal verge from September 2018 to February 2024 were included. Those with locally advanced rectal cancer underwent neoadjuvant treatment. Patients were divided into 3 groups according to the DRM: < 1 cm, 1 to 4.9 cm, and ≥ 5 cm, and compared for overall survival (OS) and disease-free survival (DFS).

Results

A total of 268 patients were included: 29 with DRM < 1 cm (11%), 208 with DRM 1 to 4.9 cm (78%), and 31 with DRM ≥ 5 cm (11%). Median follow-up was 27 months. Three-year OS was 93%, 97%, and 100% in the respective groups (P = .36); DFS was 85%, 76%, and 75% (P = .51). Multivariable analysis did not identify DRM as an independent risk factor for OS or DFS. Circumferential resection margin (CRM) involvement (HR 4.68, 95%CI 1.78-12.31) and R1 resections (HR 5.66, 95%CI 2.31-13.87) were significantly associated with disease recurrence. Subgroup analysis showed no significant impact of DRM on the survival of patients undergoing neoadjuvant therapy.

Conclusions

Short DRM does not compromise oncological outcomes, provided that complete (R0) resection is achieved. These findings support a more individualised surgical approach, with emphasis on CRM status over arbitrary DRM thresholds.

查看原文本刊更多论文

远端切除缘对肿瘤特异性直肠癌肠系膜切除术后生存率的影响：回顾性队列研究。

背景：直肠癌前切除术（AR）联合肿瘤特异性肠系膜切除术（TSME）后的安全肿瘤远端切除边缘（DRM）仍存在争议。本研究旨在阐明DRM对生存结果的影响。方法：纳入2018年9月至2024年2月期间在肛门边缘15 cm范围内接受有意治疗的非转移性直肠腺癌AR-TSME的患者。局部晚期直肠癌患者接受新辅助治疗。将患者按DRM < 1 cm、1 ~ 4.9 cm和≥5 cm分为3组，比较总生存期（OS）和无病生存期（DFS）。结果：共纳入268例患者：DRM < 1 cm 29例（11%），DRM 1 ~ 4.9 cm 208例（78%），DRM≥5 cm 31例（11%）。中位随访时间为27个月。3年OS分别为93%、97%和100% (P = 0.36)；DFS分别为85%、76%和75% （P = 0.51）。多变量分析未发现DRM是OS或DFS的独立危险因素。环切缘（CRM）受累（HR 4.68, 95%CI 1.78-12.31）和R1切除（HR 5.66, 95%CI 2.31-13.87）与疾病复发显著相关。亚组分析显示，DRM对接受新辅助治疗的患者的生存无显著影响。结论：短DRM不会影响肿瘤预后，前提是完全切除（R0）。这些发现支持更个性化的手术方法，强调CRM状态而不是任意DRM阈值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical colorectal cancer 医学-肿瘤学

CiteScore

5.50

自引率

2.90%

发文量

审稿时长

27 days

期刊介绍： Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.