Effect of preoperative chemotherapy on distal spread of low rectal cancer located close to the anus

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URI http://shark.lib.kagawa-u.ac.jp/kuir/metadata/28974
Title
Effect of preoperative chemotherapy on distal spread of low rectal cancer located close to the anus
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Description

Abstract

Purpose: This study aimed to clarify the frequency of distal spread and the optimal distal margin after preoperative chemotherapy for advanced low rectal cancer.

Methods: The study included patients with advanced lower rectal cancer who received preoperative chemotherapy and underwent surgery during 2012-2015. We investigated the distal spread of tumor cells, defined as the distal distance from the intramucosal distal tumor edge to the farthest tumor cells located under the submucosal layer. Clinical characteristics were compared for distal spreads ≥ 10 and < 10 mm, and risk factors for distal spread ≥ 10 mm were investigated.

Results: Of the 71 patients, 42 (59%) showed distal spread. Distal spreads of 1-9, 10-19, and ≥ 20 mm were observed in 27 (38%), 11 (15%), and 4 (6%) patients, respectively. Multivariate analysis revealed two independent risk factors for distal spread ≥ 10 mm after preoperative chemotherapy. The first risk factor is the presence of different therapeutic effects between the mucosal and deeper layers (meaning that superficial tumor shrinkage was evident on colonoscopy, but little tumor shrinkage was evident on magnetic resonance imaging) (odds ratio, 11.6; 95% CI, 2.22-61.3). The second risk factor is poorly differentiated or mucinous adenocarcinoma (odds ratio, 8.86; 95% CI, 1.58-49.9).

Conclusion: A distal margin of 20 mm is required (10 mm is insufficient) for advanced lower rectal cancer patients who receive preoperative chemotherapy followed by surgery. Independent risk factors for distal spread ≥ 10 mm include (1) the presence of different therapeutic effects between mucosal and deeper layers and (2) poorly differentiated or mucinous adenocarcinomas.

Keywords:

Chemotherapy; Distal margin; Distal spread; Rectal cancer

(医博甲734)

Author
著者 近藤 彰宏
著者(ヨミ) コンドウ アキヒロ
著者(別表記) Kondo Akihiro
Publication Title
International Journal of Colorectal Disease
Publication Title Alternative
Int J Colorectal Dis.
Volume
33
Issue
12
Start Page
1685
End Page
1693
Publisher
Springer
Published Date
2018-12
ISSN
0179-1958
NCID
AA11625662
PMID
30215109
DOI
10.1007/s00384-018-3159-7
Resource Type
Thesis or Dissertation
Language
eng
Rights
Copyright © 2018 Springer Nature Switzerland AG. Part of Springer Nature.
"This is the Accepted Version of the following article: Effect of preoperative chemotherapy on distal spread of low rectal cancer located close to the anus; International Journal of Colorectal Disease; Volume 33 Number 12 (2018) Pages: 1685?1693; doi: 10.1007/s00384-018-3159-7, which has been published in final form at https://link.springer.com/article/10.1007/s00384-018-3159-7 . "
エンバーゴ期間満了。 / The embargo period has expired.
出版社の著作権ポリシーにより、Accepted Versionを掲載する。
Text Version
ETD
Grant ID
博甲第734号
Grant Date
2020-03-24
Degree Name
博士(医学)
Grantor
香川大学
Set
香川大学
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