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DOES PRE‐OPERATIVE DECISION MAKING UNDERLIE THE INCREASED RATE OF POSITIVE CIRCUMFERENTIAL RESECTION MARGINS FOLLOWING ABDOMINOPERINEAL EXCISION
Author(s) -
Her J. M.,
Stebbings W. S.,
Sargen K.,
Wharton R. Q.,
Kapur S.,
Speakman C. T.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04915_24.x
Subject(s) - medicine , abdominoperineal resection , stage (stratigraphy) , radiation therapy , adjuvant radiotherapy , surgery , t stage , cancer , colorectal cancer , overall survival , paleontology , biology
A positive circumferential resection margin (CRM) is associated with local recurrence and poor oncological outcome. Studies highlight that positive CRMs occurs more often following abdominoperineal excisions (APER), compared to anterior resections (AR). However a bias towards performing APERs in patients with locally advanced tumours, or down staging prior to sphincter preserving surgery may underlie the difference. Aims: Determine (1) positive CRM rates following APER and low ARs (2) if pre‐operative decision making accounts for the difference. Methods: The last 100 low AR and 100 APERs within our unit were reviewed. Data collected included 1) Tumour distance from the anal verge, 2) Pre‐operative staging (CT / MRI) (Early stage cancers T1‐2N0, Intermediate stage – T3N0‐1, and Advanced stage – CRM threatened by tumour or involved nodes) 3) Neo‐adjuvant therapy use 4) positive CRMs. Results: One hundred Low AR were performed Between Jan 2008 – June 2004, while 100 APER were performed between Jan 2008 – Jan 2003. Average tumour distance from anal verge: APERs 3.4 cm vs. AR 5.2 cm. There was no significant difference in the pre‐operative stage (Early 28 vs. 27, Intermediate 51 vs. 58, and advanced 21 vs. 15), or the use of chemo‐radiotherapy (APER 9 vs. AR 13). There was a significant increase in CRMs in the APER group 15 vs. 7. Conclusion: A positive CRM occurred twice as often following APERs vs. low AR. This difference could not be accounted for by early cancers undergoing AR, or the use of down staging chemo‐radiotherapy.