Positive circumferential resection margins following locally advanced colon cancer surgery: Risk factors and survival impact
Author(s) -
Goffredo Paolo,
Zhou Peige,
Ginader Timothy,
Hrabe Jennifer,
GribovskajaRupp Irena,
Kapadia Muneera,
You Y. Nancy,
Hassan Imran
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25801
Subject(s) - medicine , colorectal cancer , cancer , stage (stratigraphy) , univariate analysis , oncology , lymph node , surgery , multivariate analysis , paleontology , biology
Abstract Background While the prognostic implications of positive circumferential resection margins (CRM) have been established for rectal cancer, its significance in colon cancer has not been well defined. The aim of the current study was to determine national rates for positive CRM in locally advanced colon cancer, associated factors, and survival impact. Methods The National Cancer Database was queried to identify patients with stage II‐III adenocarcinoma of the colon (2004‐2015). Results Positive CRM was identified in 9% of stage II and 12% of stage III patients. Factors associated with negative CRM included surgery in a high‐volume facility, adequate lymph‐node harvest, and negative distal/proximal margins. No difference in CRM rates was observed between surgical approaches, although having a positive CRM was significantly associated with higher conversion rates. Positive CRM was associated with significantly lower overall survival on both univariate and multivariable analysis. Conclusions Positive CRM rates exceeded 10% nationally and have an adverse impact on survival. While several tumor characteristics were identified as independent risk factors, oncologic resections and surgery at high‐volume centers were associated with lower rates of positive CRM. These findings emphasize the need for process improvement initiatives targeting modifiable factors, including adoption of appropriate oncologic techniques, standardized pathology reporting, and potential neoadjuvant strategies.