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Intersphincteric Resection for Very Low Rectal Adenocarcinoma: Univariate and Multivariate Analyses of Risk Factors for Recurrence

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to analyze the risk factors for local and distant recurrence after intersphincteric resection (ISR) for very low rectal adenocarcinoma.

Methods

One hundred twenty consecutive patients with T1–T3 rectal cancers located 1–5 (median 3) cm from the anal verge underwent ISR. Univariate and multivariate analyses of prospectively recorded clinicopathologic parameters were performed.

Results

Fifty patients had disease categorized as stage I, 21 as stage II, 46 as stage III, and 3 as stage IV on the basis of International Union Against Cancer tumor, node, metastasis staging system. Median follow-up time was 3.5 years. The 3-year rates of local and distant recurrence were 6% and 13%, respectively. Univariate analysis of the risk factors for local recurrence revealed pathologic T, pathologic stage, focal dedifferentiation, microscopic resection margins, and preoperative serum CA 19-9 level to be statistically significant. Multivariate analysis showed resection margin, focal dedifferentiation, and serum CA 19-9 level to be independently significant. Univariate analysis of the risk factors for distant recurrence indicated tumor location, combined resection, tumor annularity, pathologic N, lateral pelvic lymph node metastasis, pathologic stage, histologic grade, lymphovascular invasion, perineural invasion, and adjuvant chemotherapy to be significant. Multivariate analysis identified pathologic N, histologic grade, and tumor location to be independently significant.

Conclusion

Profiles of risk factors for local and distant recurrences after ISR are different. With local recurrence, the resection margin, focal dedifferentiation, and serum CA 19-9 level are important. For distant recurrence, the lymph node status, histologic grade, and tumor location need to be taken into account.

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References

  1. Nicholls RJ, Hall C. Treatment of non-disseminated cancer of the lower rectum. Br J Surg 1996;83:15–8.

    Article  PubMed  CAS  Google Scholar 

  2. Basso N, Minervini S, Marcelli M. Modified abdominotransanal resection for cancer of the lower third of the rectum. Dis Colon Rectum 1987;30:641–3.

    Article  PubMed  CAS  Google Scholar 

  3. Kusunoki M, Shoji Y, Yanagi H, et al. Modified anoabdominal rectal resection and colonic J-pouch anal anastomosis for lower rectal carcinoma: preliminary report. Surgery 1992;112:876–83.

    PubMed  CAS  Google Scholar 

  4. Schiessel R, Karner-Hanusch J, Herbst F, et al. Intersphincteric resection for low rectal tumors. Br J Surg 1994;81:1376–8.

    Article  PubMed  CAS  Google Scholar 

  5. Kusunoki M, Yanagi H, Shoji Y, et al. Anoabdominal rectal resection and colonic J pouch–anal anastomosis: 10 years’ experience. Br J Surg 1997;84:1277–80.

    Article  PubMed  CAS  Google Scholar 

  6. Gamagami RA, Liagre A, Chiotasso P, et al. Coloanal anastomosis for distal third rectal cancer: prospective study of oncologic results. Dis Colon Rectum 1999;42:1272–5.

    Article  PubMed  CAS  Google Scholar 

  7. Schiessel R, Novi G, Holzer B, et al. Technique and long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum 2005;48:1858–65.

    Article  PubMed  Google Scholar 

  8. Akasu T, Takawa M, Yamamoto S, et al. Incidence and patterns of recurrence after intersphincteric resection for very low rectal adenocarcinoma. J Am Coll Surg 2007;205:642–7.

    Article  PubMed  Google Scholar 

  9. Sobin LH, Wittekind CH (International Union Against Cancer), eds. TNM Classification of Malignant Tumours, 6th edition. New York: Wiley-Liss, 2002

  10. Fujita S, Shimoda T, Yoshimura K, et al. Prospective evaluation of prognostic factors in patients with colorectal cancer undergoing curative resection. J Surg Oncol 2003;84:127–31.

    Article  PubMed  Google Scholar 

  11. Ono M, Sakamoto M, Ino Y, et al. Cancer cell morphology at the invasive front and expression of cell adhesion-related carbohydrate in the primary lesion of patients with colorectal carcinoma with liver metastasis. Cancer 1996;78:1179–86.

    Article  PubMed  CAS  Google Scholar 

  12. Tominaga K, Nakanishi Y, Nimura S, et al. Predictive histopathologic factors for lymph node metastasis in patients with nonpedunculated submucosal invasive colorectal carcinoma. Dis Colon Rectum 2005;48:92–100.

    Article  PubMed  Google Scholar 

  13. Lembersky BC, Wieand HS, Petrelli NJ, et al. Oral uracil and tegafur plus leucovorin compared with intravenous fluorouracil and leucovorin in stage II and III carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project Protocol C-06. J Clin Oncol 2006;24:2059–64.

    Article  PubMed  CAS  Google Scholar 

  14. Akasu T, Moriya Y, Ohashi Y, et al. National Surgical Adjuvant Study of Colorectal Cancer Adjuvant chemotherapy with uracil-tegafur for pathological stage III rectal cancer after mesorectal excision with selective lateral pelvic lymphadenectomy: a multicenter randomized controlled trial. Jpn J Clin Oncol 2006;36:237–44.

    Article  PubMed  Google Scholar 

  15. Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638–46.

    Article  PubMed  CAS  Google Scholar 

  16. Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish rectal cancer trial. N Engl J Med 1997; 336:980–7

  17. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731–40.

    Article  PubMed  CAS  Google Scholar 

  18. Rullier E, Laurent C, Bretagnol F, et al. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg 2005;241:465–9.

    Article  PubMed  Google Scholar 

  19. Saito N, Moriya Y, Shirouzu K, et al. Intersphincteric resection in patients with very low rectal cancer: a review of the Japanese experience. Dis Colon Rectum 2006; 49(10 Suppl):S13–22

    Google Scholar 

  20. Chamlou R, Parc Y, Simon T, et al. Long-term results of intersphincteric resection for low rectal cancer. Ann Surg 2007;246:916–21.

    Article  PubMed  Google Scholar 

  21. Peeters KC, van de Velde CJ, Leer JW, et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients–a Dutch Colorectal Cancer Group Study. J Clin Oncol 2005;23:6199–206.

    Article  PubMed  CAS  Google Scholar 

  22. Pollack J, Holm T, Cedermark B, et al. Long-term effect of preoperative radiation therapy on anorectal function. Dis Colon Rectum 2006;49:345–52.

    Article  PubMed  Google Scholar 

  23. Marijnen CA, van de Velde CJ, Putter H, et al. Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 2005;23:1847–58.

    Article  PubMed  Google Scholar 

  24. Heriot AG, Tekkis PP, Fazio VW, et al. Adjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancer: a predictive model. Ann Surg 2005;242:502–11.

    PubMed  Google Scholar 

  25. MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 2006; 333:779

    Google Scholar 

  26. Ueno H, Mochizuki H, Shinto E, et al. Histologic indices in biopsy specimens for estimating the probability of extended local spread in patients with rectal carcinoma. Cancer 2002;94:2882–91.

    Article  PubMed  Google Scholar 

  27. Paty PB, Enker WE, Cohen AM, et al. Treatment of rectal cancer by low anterior resection with coloanal anastomosis. Ann Surg 1994;219:365–73.

    Article  PubMed  CAS  Google Scholar 

  28. Compton CC, Fielding LP, Burgart LJ, et al. Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 2000;124:979–94.

    PubMed  CAS  Google Scholar 

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Acknowledgments

Supported in part by a Grant-in-Aid for Clinical Research for Evidence Based Medicine, a Grant-in-Aid for Cancer Research from the Ministry of Health, Labor and Welfare, and a grant from the Foundation for Promotion of Cancer Research in Japan.

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Authors and Affiliations

  1. Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Takayuki Akasu MD, Masashi Takawa MD, Seiichiro Yamamoto MD, Tomohiro Yamaguchi MD, Shin Fujita MD & Yoshihiro Moriya MD

  2. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Seiji Ishiguro MD

  3. Pathology Division, National Cancer Center Research Institute, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Yukihiro Nakanishi MD

Authors
  1. Takayuki Akasu MD
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  2. Masashi Takawa MD
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  3. Seiichiro Yamamoto MD
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  4. Seiji Ishiguro MD
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  5. Tomohiro Yamaguchi MD
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  6. Shin Fujita MD
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  7. Yoshihiro Moriya MD
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  8. Yukihiro Nakanishi MD
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Correspondence to Takayuki Akasu MD.

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Akasu, T., Takawa, M., Yamamoto, S. et al. Intersphincteric Resection for Very Low Rectal Adenocarcinoma: Univariate and Multivariate Analyses of Risk Factors for Recurrence. Ann Surg Oncol 15, 2668–2676 (2008). https://doi.org/10.1245/s10434-008-0047-3

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  • DOI: https://doi.org/10.1245/s10434-008-0047-3

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