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Significance of Radial Margin in Patients Undergoing Complete Mesocolic Excision for Colon Cancer

Authors
 Jong Min Lee  ;  Taek Chung  ;  Kyung Min Kim  ;  Ng Siu Man Simon  ;  Yoon Dae Han  ;  Min Soo Cho  ;  Hyuk Hur  ;  Kang Young Lee  ;  Nam Kyu Kim  ;  Sat Byol Lee  ;  Ga Ram Kim  ;  Byung Soh Min 
Citation
 DISEASES OF THE COLON & RECTUM, Vol.63(4) : 488-496, 2020-04 
Journal Title
 DISEASES OF THE COLON & RECTUM 
ISSN
 0012-3706 
Issue Date
2020-04
MeSH
Adenocarcinoma / diagnosis ; Adenocarcinoma / mortality ; Adenocarcinoma / surgery* ; Aged ; Colectomy / methods* ; Colonic Neoplasms / diagnosis ; Colonic Neoplasms / mortality ; Colonic Neoplasms / surgery* ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Male ; Margins of Excision* ; Mesocolon / surgery* ; Neoplasm Staging* ; Registries* ; Republic of Korea / epidemiology ; Retrospective Studies ; Survival Rate / trends ; Treatment Outcome
Abstract
Background: Comparable to circumferential resection margin in rectal cancer, radial margin is a potential prognostic factor in colon cancer that has just begun to be studied. No previous studies have investigated the influence of radial margin in the context of complete mesocolic excision. Objective: This study aimed to examine the impact of radial margin on oncologic outcomes after complete mesocolic excision for colon cancer. Design: We retrospectively reviewed patients with stage I to III colon cancer who underwent curative resection from October 2010 to March 2013. Settings: This study was conducted using the prospective colorectal cancer registry of Severance hospital. Patients: A total of 834 consecutive patients who underwent complete mesocolic excision for colon adenocarcinoma were included. Interventions: We assigned patients into 3 groups according to radial margin distance: group A, radial margin ≥2.0 mm; group B, 1.0 ≤ radial margin < 2.0 mm; group C, radial margin <1 mm. Main outcomes and measures: Overall survival and disease-free survival were estimated. Results: On adjusted Cox regression analysis, only group C was predictive of reduced overall survival (HR, 1.90; 95% CI, 1.11-3.25; p = 0.018) and disease-free survival (HR, 1.93; 95% CI, 1.28-2.89; p = 0.001). We thereby defined radial margin threatening as radial margin <1 mm. Postoperative 5-fluorouracil (HR, 0.86; 95% CI, 0.35-2.10; p = 0.743) and FOLFOX (HR, 1.23; 95% CI, 0.57-2.64; p = 0.581) chemotherapy did not affect disease-free survival in patients with radial margin threatening. Limitations: This study has the limitations inherent in all retrospective, single-institution studies. Conclusions: Even with complete mesocolic excision, radial margin <1 mm was an independent predictor of survival and recurrence. This finding suggests that special efforts for obtaining a clear radial margin may be necessary in locally advanced colon cancer. See Video Abstract at http://links.lww.com/DCR/B125. IMPORTANCIA DEL MARGEN RADIAL EN PACIENTES SOMETIDOS A ESCISIÓN MESOCÓLICA COMPLETA PARA CÁNCER DEL COLON: Comparable al margen de resección circunferencial en cáncer rectal, el margen radial en cáncer de colon, es un factor pronóstico potencial, que recientemente comienza a estudiarse. Ningún estudio previo ha investigado la influencia del margen radial, en el contexto de la escisión mesocólica completa.Examinar en cáncer de colon, el impacto del margen radial en los resultados oncológicos, después de la escisión mesocólica completa.Revisión retrospectiva de pacientes con cáncer de colon en estadio I-III, sometidos a resección curativa de octubre 2010 a marzo 2013.Este estudio se realizó utilizando un registro prospectivo de cáncer colorrectal del hospital Severance.Se incluyeron un total de 834 pacientes consecutivos con adenocarcinoma de colon, sometidos a escisión mesocólica completa. Dividimos a los pacientes en 3 grupos según la distancia del margen radial: grupo A, margen radial ≥ 2.0 mm; grupo B, 1.0 ≤ margen radial <2.0 mm; grupo C, margen radial <1 mm.Se estimó la supervivencia general y la supervivencia libre de enfermedad.En el análisis de regresión de Cox ajustado, solo el grupo C fue predictivo de supervivencia global reducida (HR, 1.90; IC 95%, 1.11-3.25; p = 0.018) y supervivencia libre de enfermedad (HR, 1.93; IC 95%, 1.28-2.89; p = 0.001). Definimos como margen radial amenazante, un margen radial <1 mm. La quimioterapia posoperatoria con 5-FU (HR, 0,86; IC 95%, 0,35-2,10; p = 0.743) y FOLFOX (HR, 1,23; IC 95%, 0,57-2,64; p = 0,581), no afectó la supervivencia libre de enfermedad en pacientes con riesgo de margen radial.Este estudio tiene limitaciones inherentes a todos los estudios retrospectivos de una sola institución.Aun con la escisión mesocólica completa, el margen radial <1 mm fue un predictor independiente de supervivencia y recurrencia. Este hallazgo sugiere que pueden ser necesarios esfuerzos especiales para obtener un claro margen radial, en cáncer de colon localmente avanzado. Consulte Video Resumen en http://links.lww.com/DCR/B125.
Full Text
https://journals.lww.com/dcrjournal/Fulltext/2020/04000/Significance_of_Radial_Margin_in_Patients.11.aspx
DOI
10.1097/DCR.0000000000001569
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
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Lee, Kang Young(이강영)
Lee, Jong Min(이종민) ORCID logo https://orcid.org/0000-0003-1654-1533
Chung, Taek(정택) ORCID logo https://orcid.org/0000-0001-7567-0680
Cho, Min Soo(조민수)
Han, Yoon Dae(한윤대) ORCID logo https://orcid.org/0000-0002-2136-3578
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/179964
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