Valor pronóstico de la afectación del margen circunferencial en pacientes con cáncer de recto localmente avanzado

Abstract

Circumferential resection margin (CRM) involvement in patients undergoing surgery for rectal tumors is a factor predicting poor prognosis in terms of the possibility of local recurrence, distant recurrence, and survival. CRM involvement has been related to the quality of the surgery. We analyzed the rate of CRM involvement in patients with locally-advanced rectal cancer undergoing neoadjuvant therapy and its relation with disease-free survival (DFS) and disease-specific survival (DSS). A total of 101 patients diagnosed with rectal adenocarcinoma between January 2001 and December 2001 who underwent surgery after receiving neoadjuvant radiochemotherapy were included. The CRM was considered positive when the distance between the tumor and the surgical border was less than 1 mm. The relation between CRM involvement and DFS and DSS was evaluated using the log-rank test. The mean age was 66.6 years. The rate of CRM involvement was 10.8% (11 patients); CRM involvement was due to proximity or contact of the CRM with the tumor in 7 patients, proximity of enlarged nodes in 2 patients, perineural invasion in the CRM in 1 patient and discontinuous tumoral growth in 1 patient. With a mean follow-up of 25.4 months, disease recurrence was diagnosed in 13 patients: local recurrence occurred in 3 (2.97%) patients and distant metastases in 10 (9.9%). Eleven (10.8%) patients died from disease progression. CRM involvement was significantly related to DFS (p = 0.0167) and DSS (p = 0.0176). In patients undergoing surgery for rectal cancer after neoadjuvant radiochemotherapy, CRM involvement is a negative prognostic factor for DFS and DSS.