PROGNOSTIC SIGNIFICANCE OF THE CIRCUMFERENTIAL RESECTION MARGIN FOLLOWING LAPAROSCOPIC SURGERY FOR TREATMENT OF RECTAL CANCER
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Abstract
Background: Circumferential resection margin (CRM) status is one of the strongest predictors in rectal cancer. Till now, only one pilot study about CRM in rectal cancer in Vietnam was reported by the same authors. Objectives: Identifying the relationship between CRM status following laparoscopic surgery for treatment of rectal cancer and local recurrence, distant metastasis as well as survival of patients with rectal cancer. Materials and methods: In this prospective study, patients with rectal cancer who underwent laparoscopic surgery according to the principles of total mesorectal excision (TME) were extracted at Can Tho University of Medicine and Pharmacy Hospital. Results: All data and CRM of 68 patients were collected. Average postoperative follow–up was 20.9±9.2 months. CRM involvement in 30.9%. Local recurrence occurred in 8.8%. Distant metastasis occurred in 14.7% of patients with rectal carcinoma. Local recurrence rate of patients with positive circumferential resection margin was 23.8%, whereas it was 2.1% in those with negative circumferential resection margin (p=0.003). Distant recurrence was observed in 38.1% of patients with positive circumferential resection margin; conversely, it was 4.2% in those with negative circumferential resection margin (p<0.001). Kaplan - Meier survival analysis showed significant improvements in median survival (37.3±1.1 mo, 95%CI:(35.1–39.5) mo vs 27.3±2.8 mo, 95%CI:(21.9–32.8) mo) for circumferential resection margin-negative patients over circumferential resection margin-positive patients (log-rank, p<0.001). Conclusions: The circumferential resection margin status is an important predictor of local and distant recurrence as well as survival of patients with rectal cancer.
Keywords
rectal cancer, laparoscopic surgery, circumferential resection margin, prognostic factor
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