Annals of Surgical Oncology

, Volume 14, Issue 2, pp 462–469 | Cite as

Prognostic Significance of Circumferential Resection Margin Following Total Mesorectal Excision and Adjuvant Chemoradiotherapy in Patients with Rectal Cancer

  • Seung Hyuk Baik
  • Nam Kyu Kim
  • Young Chan Lee
  • Hoguen Kim
  • Kang Young Lee
  • Seung Kook Sohn
  • Chang Hwan Cho



This study was designed to evaluate the prognostic value of circumferential resection margin (CRM) in rectal cancer patients who underwent curative resection with adjuvant chemoradiotherapy (CRT).


We studied 504 patients who underwent total mesorectal excision with adjuvant CRT for rectal cancer between 1997 and 2001. The patients were divided into two groups: a negative CRM group (CRM > 1 mm) and a positive CRM group (CRM ≤ 1 mm). The survival rates, local recurrence rates, and systemic recurrence rates were compared between groups.


The negative CRM group had 460 patients and the positive CRM group had 44 patients. The 5-year local and systemic recurrence rates were 11.3 and 25.3%, respectively, in the negative CRM group and 35.2 and 60.8% in the positive CRM group, respectively. The cancer-specific 5-year survival rates for the two groups were 72.5 and 26.9% (P < .001), respectively. CRM was found to be an independent prognostic factor by multivariate analyses which were adjusted for known outcome predictors (P < .001).


Oncological outcome for patients in the positive CRM group is less favorable than for those in the negative CRM group. Adjuvant CRT is not a definite treatment modality that can be used to compensate for a positive CRM following TME and adjuvant CRT in patients with TNM stage II or III rectal cancer.


Circumferential resection margin Total mesorectal excision Rectal cancer Adjuvant chemoradiotherapy 



This study was supported by a grant from the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (0412-CR01-0704-0001).


  1. 1.
    Nymann T, Jess P, Christiansen J. Rate and treatment of pelvic recurrence after abdominoperineal resection and low anterior resection for rectal cancer. Dis Colon Rectum 1995; 38:799–802PubMedCrossRefGoogle Scholar
  2. 2.
    Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer 1984; 53:1354–62PubMedCrossRefGoogle Scholar
  3. 3.
    Pahlman L, Glimelius B. Local recurrences after surgical treatment for rectal carcinoma. Acta Chir Scand 1984; 150:331–5PubMedGoogle Scholar
  4. 4.
    Heald RJ. A new approach to rectal cancer. Br J Hosp Med 1979; 22:277–81PubMedGoogle Scholar
  5. 5.
    Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1987–1997. Arch Surg 1998; 133:894–9PubMedCrossRefGoogle Scholar
  6. 6.
    Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 1995; 181;335–46PubMedGoogle Scholar
  7. 7.
    Heald RJ, Ryall RD. Recurrence, survival after total mesorectal excision for rectal cancer. Lancet 1986; I:1479–82CrossRefGoogle Scholar
  8. 8.
    Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 1982; 69:613–6PubMedCrossRefGoogle Scholar
  9. 9.
    Frykholm GJ, Glimelius B, Pahlman L. Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effects. Dis Colon Rectum 1993; 36:564–72PubMedCrossRefGoogle Scholar
  10. 10.
    Treurniet-Donker AD, van Putten WL, Wereldsma JC, et al. Postoperative radiation therapy for rectal cancer. An interim analysis of a prospective, randomized multicenter trial in The Netherlands. Cancer 1991; 67:2042–8PubMedCrossRefGoogle Scholar
  11. 11.
    Birbeck KF, Macklin CP, Tiffin NJ, et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 2002; 235:449–57PubMedCrossRefGoogle Scholar
  12. 12.
    Cawthorn SJ, Parums DV, Gibbs NM, A’Hern RP, Caffarey SM, Broughton CI, Marks CG. Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer. Lancet 1990; 335:1055–9PubMedCrossRefGoogle Scholar
  13. 13.
    Wibe A, Rendedal PR, Svensson E, Norstein J, Eide TJ, Myrvold HE, Soreide O. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 2003; 89:327–34CrossRefGoogle Scholar
  14. 14.
    Marijnen CA, Nagtegaal ID, Kapiteijn E, et al. Radotherapy does not compensate for positive resection margin in rectal cancer patients: report of a multicenter radomized trial. Int J Radiat Oncol Biol Phys 2003; 55:1311–20PubMedGoogle Scholar
  15. 15.
    Greene FL, Page DL, Fleming ID, et al. AJCC cancer staging manual, 6th edn. New York: Springer-Verlag (2002)Google Scholar
  16. 16.
    NIH consensus conference: adjuvant therapy for patients with colon and rectal cancer. JAMA 1990; 264:1444–50CrossRefGoogle Scholar
  17. 17.
    Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumor spread and surgical excision. Lancet 1986; 2:996–9PubMedCrossRefGoogle Scholar
  18. 18.
    Adam IJ, Mohamdee MO, Martin IG, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 1994; 344:701–11CrossRefGoogle Scholar
  19. 19.
    Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for respectable rectal cancer. N Engl J Med 2001; 345:638–6PubMedCrossRefGoogle Scholar
  20. 20.
    Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351:1731–40PubMedCrossRefGoogle Scholar
  21. 21.
    Wiggers T, van de Velde CJ. The circumferential margin in rectal cancer: recommendations based on the Dutch Total Mesorectal Excision Study. Eur J Cancer 2002; 38:973–6PubMedCrossRefGoogle Scholar
  22. 22.
    Compton C, Fenoglio-Preiser CM, Pettigrew N, Fielding LP. American Joint Committee on Cancer prognostic factors consensus conference: colorectal working group. Cancer 2000; 88:1739–57PubMedCrossRefGoogle Scholar
  23. 23.
    Nagtegaal ID, Marijnen CA, Kranenbarg EK, van de Velde CJ, van Krieken JH, Pathology Review Committee; Cooperative Clinical Investigators. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 2002; 26:350–7PubMedCrossRefGoogle Scholar
  24. 24.
    Zhu AX, Willett CG. Combined modality treatment for rectal cancer. Semin Oncol 2005; 32:103–12PubMedCrossRefGoogle Scholar
  25. 25.
    Kim NK, Kim MJ, Park JK, Park SI, Min JS. Preoperative staging of rectal cancer with MRI: accuracy and clinical usefulness. Ann Surg Oncol 2000; 7:732–7PubMedCrossRefGoogle Scholar
  26. 26.
    Martling A, Holm T, Bremmer S, Lindholm J, Cedermark B, Blomqvist L. Prognostic value of preoperative magnetic resonance imaging of the pelvis in rectal cancer. Br J Surg 2003; 90:1422–8PubMedCrossRefGoogle Scholar
  27. 27.
    Beets-Tan RG. MRI in rectal cancer: the T stage and circumferential resection margin. Colorectal Dis 2003; 5:392–5PubMedCrossRefGoogle Scholar
  28. 28.
    Beets-Tan RG, Beets GL, Vliegen RF, et al. Accuracy of magnetic resonance imaging in rectal cancer surgery. Lancet 2001; 357:497–504PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2006

Authors and Affiliations

  • Seung Hyuk Baik
    • 1
  • Nam Kyu Kim
    • 1
    • 3
  • Young Chan Lee
    • 1
  • Hoguen Kim
    • 2
  • Kang Young Lee
    • 1
  • Seung Kook Sohn
    • 1
  • Chang Hwan Cho
    • 1
  1. 1.Department of SurgeryYonsei University College of MedicineSeoulSouth Korea
  2. 2.Department of PathologyYonsei University College of MedicineSeoulSouth Korea
  3. 3.SeoulSouth Korea

Personalised recommendations