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Factors associated with anastomotic recurrence after total mesorectal excision in rectal cancer patients

Authors
 YOUNG-WAN KIM  ;  NAM-KYU KIM  ;  BYUNG-SOH MIN  ;  HYUK HUH  ;  JIN-SOO KIM  ;  JEONG-YEON KIM  ;  SEUNG-KOOK SOHN  ;  CHANG-HWAN CHO 
Citation
 JOURNAL OF SURGICAL ONCOLOGY, Vol.99(1) : 58-64, 2009 
Journal Title
 JOURNAL OF SURGICAL ONCOLOGY 
ISSN
 0022-4790 
Issue Date
2009
MeSH
Adenocarcinoma/pathology* ; Adenocarcinoma/surgery ; Anastomosis, Surgical ; Digestive System Surgical Procedures ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology* ; Rectal Neoplasms/pathology* ; Rectal Neoplasms/surgery ; Rectal Neoplasms/therapy ; Rectum/pathology* ; Risk Factors ; Survival Analysis
Keywords
rectal neoplasm ; total mesorectal excision ; anastomotic recurrence ; distal margin
Abstract
BACKGROUND: In patients undergoing total mesorectal excision (TME), the clinical variables most relevant to anastomotic recurrence have not been identified. We evaluated factors associated with anastomotic recurrence in patients undergoing TME and the impact of a reduced distal margin on anastomotic recurrence. METHODS: Thirty-eight patients with anastomotic recurrence were compared with 876 patients who received curative rectal cancer surgery. Patients were compared according to: (1) the presence of anastomotic recurrence (recurrence vs. recurrence-free), (2) distal margin length (< or =10 mm vs. >10 mm) and (3) additional treatment (none, adjuvant, or neoadjuvant). The risk factors for anastomotic recurrence were analyzed. RESULTS: In the recurrence group, an advanced T stage (T3 and T4) (P = 0.01) microscopic distal margin involvement (P = 0.002) and an elevated CEA level (>5 ng/ml) (P = 0.04) were more commonly found. The incidence of anastomotic recurrence was not higher in the distal margin < or =10 mm group and did not differ according to additional treatment. The multivariate analysis showed that an advanced T stage (T3 and T4) and microscopic distal margin involvement were risk factors for anastomotic recurrence. CONCLUSION: A distal margin < or =10 mm appears to be acceptable in terms of anastomotic recurrence. Patients with a positive distal margin, on the postoperative pathology, should be considered at high risk for anastomotic recurrence.
Full Text
http://onlinelibrary.wiley.com/doi/10.1002/jso.21166/abstract
DOI
10.1002/jso.21166
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Kim, Young Wan(김영완)
Kim, Jeong Yeon(김정연)
Kim, Jin Soo(김진수)
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Sohn, Seung Kook(손승국)
Cho, Chang Hwan(조장환)
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/103363
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