Resection margin predicts survival in rectal cancer

Most patients with locally recurrent rectal cancer can be resected for cure, for which preoperative carcinoembryonic antigen and R0 resection margin are the only predictors of survival, finds the latest Diseases of the Colon and Rectum.

Few biologic markers have been studied as prognostic factors in recurrent rectal carcinoma patients.

Dr Isabelle Bedrosian and colleagues from Texas assessed variables that effect survival after curative resection of locally recurrent rectal cancer.

The research team conducted a retrospective review of 134 patients with locally recurrent rectal cancer who received surgery with curative intent from 1988 to 1998.

Curative resection was performed in 85 patients.

The team reported that the median follow-up was 43 months.

On multivariate analysis, negative predictors of overall survival included an elevated carcinoembryonic antigen level.

The researchers found that an R1 resection margin was also a negative predictor of overall survival.

Biological markers p53, bcl-2, and ki-67 did not impact survival outcomes

Diseases of the Colon & Rectum

In 26 patients for whom biologic variables were available, p53, bcl-2, and ki-67 did not significantly impact disease-specific survival or overall survival.

The team noted that the 5-year disease-specific survival, overall survival, and pelvic control rates were 46%, 36%, and 51 % respectively.

Of the 50 patients who relapsed, time to second local recurrence was longer than time to development of metastasis.

The team observed that the median survival for patients with metastatic recurrence was 26 vs 42 months for those with a local recurrence alone.

Dr Bedrosian's team concluded, “Approximately 75% of patients with locally recurrent rectal cancer can be resected for cure.”

“Preoperative carcinoembryonic antigen and an R0 resection margin were the only significant predictors of overall survival.”

“p53, bcl-2, and ki-67 did not impact survival outcomes.”