Knut M Augestad1, Deborah S Keller2, Paul M Bakaki3, Johnie Rose4, Siran M Koroukian5, Tom Øresland6, Conor P Delaney7. 1. Department of Gastrointestinal Surgery, Akershus University Hospital, Norway; Department of Gastrointestinal Surgery, Nordland Hospital Trust, Bodø, Norway; Department of Gastrointestinal Surgery, Akershus University Hospital, Oslo, Norway. Electronic address: knut.magne.augestad@unn.no. 2. Division of Colon and Rectal Surgery, Department of Surgery, Baylor University Medical Center, Dallas, TX, USA. 3. Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, OH, USA. 4. Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA. 5. Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA. 6. Department of Gastrointestinal Surgery, Akershus University Hospital, Oslo, Norway. 7. Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Abstract
BACKGROUND: The impact of rectal cancer tumor height on local recurrence and metastatic spread is unknown. The objective was to evaluate the impact of rectal cancer tumor height from the anal verge on metastatic spread and local recurrence patterns. METHODS: The Norwegian nationwide surgical quality registry was reviewed for curative rectal cancer resections from 1/1/1996-12/15/2006. Cancers were stratified into five height groups: 0-3 cm, >3-5 cm, >5-9 cm, >9-12 cm, 12 cm-HI. Competing risk and proportional hazards models assessed the relationship between tumor height and patterns of metastasis and survival. RESULTS: 6859 patients were analyzed. After median follow-up of 52 months (IQR 20-96), 26.7% (n = 1835) experienced recurrence. With tumors >12 cm, the risk of liver metastases increased (crude HR 1.49, p = 0.03), while lung metastases decreased (crude HR 0.66, p = 0.03), and risk of death decreased (crude HR 0.81, p = 0.001) The cumulative incidence of pelvic recurrence were highest for the low tumors (p = 0.01). Median time to liver metastases was 14months (IQR 7-24), lung metastases 25months (IQR 13-39), pelvic recurrence 19months (IQR10-32), (p < 0.0001). Time to metastases in liver and lungs were significantly associated with tumor height (p < 0.001) CONCLUSION: There are distinct differences in metastatic recurrence patterns and time to recurrence from different anatomic areas of the rectum. In crude analyses, tumor height impacted metastatic spread to the liver and lungs. However, when adjusting for treatment variables, the hazard of metastatic spread to the liver and lungs are limited. Nevertheless, time to metastases in liver and lungs is significantly impacted by tumor height. Venous drainage of the rectal cancer may be a significant contributor of rectal cancer metastatic spread, but further research is warranted.
BACKGROUND: The impact of rectal cancertumor height on local recurrence and metastatic spread is unknown. The objective was to evaluate the impact of rectal cancertumor height from the anal verge on metastatic spread and local recurrence patterns. METHODS: The Norwegian nationwide surgical quality registry was reviewed for curative rectal cancer resections from 1/1/1996-12/15/2006. Cancers were stratified into five height groups: 0-3 cm, >3-5 cm, >5-9 cm, >9-12 cm, 12 cm-HI. Competing risk and proportional hazards models assessed the relationship between tumor height and patterns of metastasis and survival. RESULTS: 6859 patients were analyzed. After median follow-up of 52 months (IQR 20-96), 26.7% (n = 1835) experienced recurrence. With tumors >12 cm, the risk of liver metastases increased (crude HR 1.49, p = 0.03), while lung metastases decreased (crude HR 0.66, p = 0.03), and risk of death decreased (crude HR 0.81, p = 0.001) The cumulative incidence of pelvic recurrence were highest for the low tumors (p = 0.01). Median time to liver metastases was 14months (IQR 7-24), lung metastases 25months (IQR 13-39), pelvic recurrence 19months (IQR10-32), (p < 0.0001). Time to metastases in liver and lungs were significantly associated with tumor height (p < 0.001) CONCLUSION: There are distinct differences in metastatic recurrence patterns and time to recurrence from different anatomic areas of the rectum. In crude analyses, tumor height impacted metastatic spread to the liver and lungs. However, when adjusting for treatment variables, the hazard of metastatic spread to the liver and lungs are limited. Nevertheless, time to metastases in liver and lungs is significantly impacted by tumor height. Venous drainage of the rectal cancer may be a significant contributor of rectal cancer metastatic spread, but further research is warranted.
Authors: Olga A Lavryk; Elena Manilich; Michael A Valente; Arshiya Miriam; Emre Gorgun; Matthew F Kalady; Sherief Shawki; Conor P Delaney; Scott R Steele Journal: Int J Colorectal Dis Date: 2019-11-27 Impact factor: 2.571
Authors: David D B Bates; James L Fuqua; Junting Zheng; Marinela Capanu; Jennifer S Golia Pernicka; Sidra Javed-Tayyab; Viktoriya Paroder; Iva Petkovska; Marc J Gollub Journal: Abdom Radiol (NY) Date: 2020-09-17
Authors: Sebastian Meltzer; Kine Mari Bakke; Karina Lund Rød; Anne Negård; Kjersti Flatmark; Arne Mide Solbakken; Annette Torgunrud Kristensen; Anniken Jørlo Fuglestad; Christian Kersten; Svein Dueland; Therese Seierstad; Knut Håkon Hole; Lars Gustav Lyckander; Finn Ole Larsen; Jakob Vasehus Schou; Dawn Patrick Brown; Hanna Abrahamsson; Kathrine Røe Redalen; Anne Hansen Ree Journal: Clin Transl Radiat Oncol Date: 2019-12-02
Authors: Annette Torgunrud; Hanna Abrahamsson; Sebastian Meltzer; Arne Mide Solbakken; Kjersti Flatmark; Svein Dueland; Kine Mari Bakke; Paula Anna Bousquet; Anne Negård; Christin Johansen; Lars Gustav Lyckander; Finn Ole Larsen; Jakob Vasehus Schou; Kathrine Røe Redalen; Anne Hansen Ree Journal: Br J Cancer Date: 2021-04-09 Impact factor: 7.640