Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery

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Abstract
Background. Ascertaining the optimal distal margin of resection in sphincter-preserving surgery has become an important problem. This study was designed to examine distal rectal spread of rectal carcinoma and to determine the optimal distal margin of resection for sphincter-preserving surgery. Methods. Six hundred ten consecutive specimens of resected rectal carcinomas were analyzed retrospectively and pathologically. Results. Sixty-one patients (10%) had distal spread. In patients who underwent curative surgery, distal spread was observed in only 3.8% (19/505). Distal spread was not found in patients with Stage I disease (0/150), according to the International Union Against Cancer stage. Only 1.2% (2/162) of patients with Stage II disease and 5.1% (10/195) with Stage III disease had slight spread but this was confined within a 1 cm length. Most patients with distal spread had a lower survival rate and died of distant metastasis rather than local recurrence, even after curative surgery. Conclusions. Distal spread seems to be an important risk factor for distant metastasis. Distal margin of resection of 1 cm may be appropriate clearance for most rectal cancers. Cancer 1995;76:388–92.