Effect of preoperative chemotherapy on distal spread of low rectal cancer located close to the anus
PURPOSE: This study aimed to clarify the frequency of distal spread and the optimal distal margin after preoperative chemotherapy for advanced low rectal cancer.
METHODS: The study included patients with advanced lower rectal cancer who received preoperative chemotherapy and underwent surgery during 2012-2015. We investigated the distal spread of tumor cells, defined as the distal distance from the intramucosal distal tumor edge to the farthest tumor cells located under the submucosal layer. Clinical characteristics were compared for distal spreads ≥ 10 and < 10 mm, and risk factors for distal spread ≥ 10 mm were investigated.
RESULTS: Of the 71 patients, 42 (59%) showed distal spread. Distal spreads of 1-9, 10-19, and ≥ 20 mm were observed in 27 (38%), 11 (15%), and 4 (6%) patients, respectively. Multivariate analysis revealed two independent risk factors for distal spread ≥ 10 mm after preoperative chemotherapy. The first risk factor is the presence of different therapeutic effects between the mucosal and deeper layers (meaning that superficial tumor shrinkage was evident on colonoscopy, but little tumor shrinkage was evident on magnetic resonance imaging) (odds ratio, 11.6; 95% CI, 2.22-61.3). The second risk factor is poorly differentiated or mucinous adenocarcinoma (odds ratio, 8.86; 95% CI, 1.58-49.9).
CONCLUSION: A distal margin of 20 mm is required (10 mm is insufficient) for advanced lower rectal cancer patients who receive preoperative chemotherapy followed by surgery. Independent risk factors for distal spread ≥ 10 mm include (1) the presence of different therapeutic effects between mucosal and deeper layers and (2) poorly differentiated or mucinous adenocarcinomas.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:33 |
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| Enthalten in: |
International journal of colorectal disease - 33(2018), 12 vom: 27. Dez., Seite 1685-1693 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kondo, Akihiro [VerfasserIn] |
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| Links: |
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| Themen: |
Chemotherapy |
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| Anmerkungen: |
Date Completed 08.02.2019 Date Revised 15.02.2019 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00384-018-3159-7 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM288520858 |
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| 500 | |a Date Revised 15.02.2019 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a PURPOSE: This study aimed to clarify the frequency of distal spread and the optimal distal margin after preoperative chemotherapy for advanced low rectal cancer | ||
| 520 | |a METHODS: The study included patients with advanced lower rectal cancer who received preoperative chemotherapy and underwent surgery during 2012-2015. We investigated the distal spread of tumor cells, defined as the distal distance from the intramucosal distal tumor edge to the farthest tumor cells located under the submucosal layer. Clinical characteristics were compared for distal spreads ≥ 10 and < 10 mm, and risk factors for distal spread ≥ 10 mm were investigated | ||
| 520 | |a RESULTS: Of the 71 patients, 42 (59%) showed distal spread. Distal spreads of 1-9, 10-19, and ≥ 20 mm were observed in 27 (38%), 11 (15%), and 4 (6%) patients, respectively. Multivariate analysis revealed two independent risk factors for distal spread ≥ 10 mm after preoperative chemotherapy. The first risk factor is the presence of different therapeutic effects between the mucosal and deeper layers (meaning that superficial tumor shrinkage was evident on colonoscopy, but little tumor shrinkage was evident on magnetic resonance imaging) (odds ratio, 11.6; 95% CI, 2.22-61.3). The second risk factor is poorly differentiated or mucinous adenocarcinoma (odds ratio, 8.86; 95% CI, 1.58-49.9) | ||
| 520 | |a CONCLUSION: A distal margin of 20 mm is required (10 mm is insufficient) for advanced lower rectal cancer patients who receive preoperative chemotherapy followed by surgery. Independent risk factors for distal spread ≥ 10 mm include (1) the presence of different therapeutic effects between mucosal and deeper layers and (2) poorly differentiated or mucinous adenocarcinomas | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Chemotherapy | |
| 650 | 4 | |a Distal margin | |
| 650 | 4 | |a Distal spread | |
| 650 | 4 | |a Rectal cancer | |
| 700 | 1 | |a Tsukada, Yuichiro |e verfasserin |4 aut | |
| 700 | 1 | |a Kojima, Motohiro |e verfasserin |4 aut | |
| 700 | 1 | |a Nishizawa, Yuji |e verfasserin |4 aut | |
| 700 | 1 | |a Sasaki, Takeshi |e verfasserin |4 aut | |
| 700 | 1 | |a Suzuki, Yasuyuki |e verfasserin |4 aut | |
| 700 | 1 | |a Ito, Masaaki |e verfasserin |4 aut | |
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