• Wijnand J Alberda, Cornelis Verhoef, Marguerite E I Schipper, Joost J Nuyttens, Joost Rothbarth, Johannes H W de Wilt, and Jabobus W A Burger.
• 1 Division of Surgical Oncology, Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands 2 Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands 3 Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, the Netherlands 4 Division of Surgical Oncology, Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
• Dis. Colon Rectum. 2015 Jul 1; 58 (7): 677-85.

BackgroundThe importance of the circumferential resection margin has been demonstrated in primary rectal cancer, but the role of the minimal tumor-free resection margin in locally recurrent rectal cancer is unknown.ObjectiveThe purpose of this work was to evaluate the prognostic importance of a minimal tumor-free resection margin in locally recurrent rectal cancer.DesignThis was a single-institution, retrospective study.SettingsThis study was conducted in a tertiary referral hospital.PatientsBased on the final pathology report, surgically treated patients with locally recurrent rectal cancer between 1990 and 2013 were divided into 4 groups: 1) tumor-free margins of >2 mm, 2) tumor-free margins of >0 to 2 mm, 3) microscopically involved margins, and 4) macroscopically involved margins.Main Outcome MeasuresLocal control and overall survival were the main outcome measures.ResultsA total of 174 patients with a median follow-up of 27 months (range, 0-144 months) were eligible for analysis. There was a significant difference in 5-year local re-recurrence-free survival in favor of 41 patients with tumor-free margins of >2 mm compared with 34 patients with tumor-free margins of >0 to 2 mm (80% vs 62%; p = 0.03) and a significant difference in 5-year overall survival (60% vs 37%; p = 0.01). The 5-year local re-recurrence-free and overall survival rates for 55 patients with microscopically involved margins were 28% and 16%, and for 20 patients with macroscopically involved margins the rates were 0% and 5%. On multivariable analysis, tumor-free margins of >0 to 2 mm were independently associated with higher re-recurrence rates (HR, 2.76 (95% CI, 1.06-7.16)) and poorer overall survival (HR, 2.57 (95% CI, 1.27-5.21)) compared with tumor-free margins of >2 mm.LimitationsThis study was limited by its retrospective nature.ConclusionsResection margin status is an independent prognostic factor for re-recurrence rate and overall survival in surgically treated, locally recurrent rectal cancer. In complete resections, patients with tumor-free resection margins of >0 to 2 mm have a higher re-recurrence rate and a poorer overall survival than patients with tumor-free resection margins of >2 mm.

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