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Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons
57th Annual Meeting Abstracts


Poster 14

Abstract Title

Nine out of ten patients with T1 rectal cancer do not need radical surgery. But who is the one that does?

 

Author Block

Harry M. Salinas, MD1, Abdulmetin Dursun, MD1, C. L. Klos, MD2, Paul Shellito, MD1, Patricia Sylla, MD1, David Berger, MD1, Liliana Bordeianou, MD1

1Massachusetts General Hospital, Boston, MA 2Universiteit van Amsterdam, Amsterdam, Netherlands

 

Abstract Body

Background: Local resection of T1-T2 rectal cancer results in lower morbidity than radical resection. Higher recurrence rates follow local resection, likely due to lymph node involvement. Predictors of lymph node metastasis remain inconsistent in the literature. While local resection may be appropriate for some patients, selection criteria remain unclear.

Methods: The records of 82 consecutive patients who underwent radical resection of T1-T2 rectal cancer were reviewed. Various factors from patientís history, physical, radiologic, and pathologic data were evaluated as predictors of positive nodes.

Results:† Despite preoperative staging with MRI, CT or PET, 11.4% (4/35) of T1 and 27.7% (13/47) of T2 patients had positive nodes. On univariate analysis, the only significant predictor in patients with radiologically negative nodes was depth of invasion: 52.2% of patients with negative nodes vs 86.7% w/ positive nodes had tumors abuting the muscularis propria (p=0.018). On logistic regression analysis incorporating depth, size, distance from anal verge, differentiation, adjacent structure invasion, and lymphovascular/perineural/or vascular invasion; only depth of invasion remained significant. (OR: 0.13, P=0.033; OR: 0.6, P=0.16; OR: 0.89, P=0.084; OR: 0.11, P=0.302; OR: 0.62, p=0.586; OR: 1.35, p=0.826; respectively)

 

Conclusions: 88.6% of patients with T1 and 72.3% of patients with T2 disease undergo unnecessary radical surgery. Preoperative staging with MRI, CT scans and PET scans cannot identify these patients reliably. Markers of aggressive disease are not helpful. Thus, local resection for T2 rectal cancer is not justified. It should only be offered to motivated patients with T1 disease who will comply with aggressive postoperative surveillance.

 

 

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