Prognostic significance of circumferential margin involvement in rectal adenocarcinoma treated with preoperative chemoradiotherapy and low anterior resection

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Abstract
Introduction Histologic examination of circumferential margins is an important predictor of local and distant relapse in non‐radiated rectal cancer. However, for patients who received preoperative chemoradiotherapy this role has not yet been addressed. Methods From January 1995 to December 1997, 61 patients with rectal adenocarcinoma located between 0 and 10 cm from anal verge with invasion into perirectal fat assessed by rectal ultrasound were included. All patients received 45 Gy + bolus infusion of 5‐FU (450 mg/m2/days 1–5, 28–33 of RT); 4–6 weeks later, surgery was performed. Circumferential margin was assessed (P = 0.33). Distant recurrence was observed in 22% of patients without circumferential margin involvement; conversely, it was 58.3% in those with involvement (P = 0.02). Five‐year survival of patients without circumferential resection involvement margin was 81%, while it was 42% in patients with circumferential involvement (P = 0.006). Conclusions In patients with rectal cancer treated by preoperative chemoradiation plus total mesorectal excision (TME) and sphincter saving surgery, circumferential margin involvement is associated with high incidence of distant recurrence and cancer‐related death. J. Surg. Oncol. 2005;90:20–25.