Sapho X Roodbeen1, F B de Lacy2, Susan van Dieren3, Marta Penna4, Frédéric Ris5, Brendan Moran6, Paris Tekkis7, Willem A Bemelman1, Roel Hompes1. 1. Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands. 2. Gastrointestinal Surgery Department, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain. 3. Department of Surgery and Clinical Epidemiology, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands. 4. Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospital NHS Foundation Trust, Oxford, UK. 5. Service of Visceral surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland. 6. Department of Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK. 7. Department of Colorectal Surgery, The Royal Marsden Hospital, Imperial College London, UK.
Abstract
OBJECTIVE: The aim of this study was to determine the incidence of, and preoperative risk factors for, positive circumferential resection margin (CRM) after transanal total mesorectal excision (TaTME). BACKGROUND: TaTME has the potential to further reduce the rate of positive CRM for patients with low rectal cancer, thereby improving oncological outcome. METHODS: A prospective registry-based study including all cases recorded on the international TaTME registry between July 2014 and January 2018 was performed. Endpoints were the incidence of, and predictive factors for, positive CRM. Univariate and multivariate logistic regressions were performed, and factors for positive CRM were then assessed by formulating a predictive model. RESULTS: In total, 2653 patients undergoing TaTME for rectal cancer were included. The incidence of positive CRM was 107 (4.0%). In multivariate logistic regression analysis, a positive CRM after TaTME was significantly associated with tumors located up to 1 cm from the anorectal junction, anterior tumors, cT4 tumors, extra-mural venous invasion (EMVI), and threatened or involved CRM on baseline MRI (odds ratios 2.09, 1.66, 1.93, 1.94, and 1.72, respectively). The predictive model showed adequate discrimination (area under the receiver-operating characteristic curve >0.70), and predicted a 28% risk of positive CRM if all risk factors were present. CONCLUSION: Five preoperative tumor-related characteristics had an adverse effect on CRM involvement after TaTME. The predicted risk of positive CRM after TaTME for a specific patient can be calculated preoperatively with the proposed model and may help guide patient selection for optimal treatment and enhance a tailored treatment approach to further optimize oncological outcomes.
OBJECTIVE: The aim of this study was to determine the incidence of, and preoperative risk factors for, positive circumferential resection margin (CRM) after transanal total mesorectal excision (TaTME). BACKGROUND: TaTME has the potential to further reduce the rate of positive CRM for patients with low rectal cancer, thereby improving oncological outcome. METHODS: A prospective registry-based study including all cases recorded on the international TaTME registry between July 2014 and January 2018 was performed. Endpoints were the incidence of, and predictive factors for, positive CRM. Univariate and multivariate logistic regressions were performed, and factors for positive CRM were then assessed by formulating a predictive model. RESULTS: In total, 2653 patients undergoing TaTME for rectal cancer were included. The incidence of positive CRM was 107 (4.0%). In multivariate logistic regression analysis, a positive CRM after TaTME was significantly associated with tumors located up to 1 cm from the anorectal junction, anterior tumors, cT4 tumors, extra-mural venous invasion (EMVI), and threatened or involved CRM on baseline MRI (odds ratios 2.09, 1.66, 1.93, 1.94, and 1.72, respectively). The predictive model showed adequate discrimination (area under the receiver-operating characteristic curve >0.70), and predicted a 28% risk of positive CRM if all risk factors were present. CONCLUSION: Five preoperative tumor-related characteristics had an adverse effect on CRM involvement after TaTME. The predicted risk of positive CRM after TaTME for a specific patient can be calculated preoperatively with the proposed model and may help guide patient selection for optimal treatment and enhance a tailored treatment approach to further optimize oncological outcomes.
Authors: S E van Oostendorp; S X Roodbeen; C C Chen; A Caycedo-Marulanda; H M Joshi; P J Tanis; C Cunningham; J B Tuynman; R Hompes Journal: Tech Coloproctol Date: 2020-06-16 Impact factor: 3.781
Authors: N S Fearnhead; A G Acheson; S R Brown; L Hancock; A Harikrishnan; S B Kelly; C A Maxwell-Armstrong; P M Sagar; S Siddiqi; C J Walsh; J M D Wheeler; J F Abercrombie Journal: Colorectal Dis Date: 2020-07 Impact factor: 3.788
Authors: Antonio Caycedo-Marulanda; Lawrence Lee; Sami A Chadi; Chris P Verschoor; Jordan Crosina; Shady Ashamalla; Carl J Brown Journal: JAMA Netw Open Date: 2021-02-01