Cargando…

Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial

BACKGROUND: Local recurrence rates in operable rectal cancer are improved by radiotherapy (with or without chemotherapy) and surgical techniques such as total mesorectal excision. However, the contributions of surgery and radiotherapy to outcomes are unclear. We assessed the effect of the involvemen...

Descripción completa

Detalles Bibliográficos
Autores principales: Quirke, Phil, Steele, Robert, Monson, John, Grieve, Robert, Khanna, Subhash, Couture, Jean, O'Callaghan, Chris, Myint, Arthur Sun, Bessell, Eric, Thompson, Lindsay C, Parmar, Mahesh, Stephens, Richard J, Sebag-Montefiore, David
Formato: Texto
Lenguaje:English
Publicado: Lancet Publishing Group 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2668948/
https://www.ncbi.nlm.nih.gov/pubmed/19269520
http://dx.doi.org/10.1016/S0140-6736(09)60485-2
_version_ 1782166220781387776
author Quirke, Phil
Steele, Robert
Monson, John
Grieve, Robert
Khanna, Subhash
Couture, Jean
O'Callaghan, Chris
Myint, Arthur Sun
Bessell, Eric
Thompson, Lindsay C
Parmar, Mahesh
Stephens, Richard J
Sebag-Montefiore, David
author_facet Quirke, Phil
Steele, Robert
Monson, John
Grieve, Robert
Khanna, Subhash
Couture, Jean
O'Callaghan, Chris
Myint, Arthur Sun
Bessell, Eric
Thompson, Lindsay C
Parmar, Mahesh
Stephens, Richard J
Sebag-Montefiore, David
author_sort Quirke, Phil
collection PubMed
description BACKGROUND: Local recurrence rates in operable rectal cancer are improved by radiotherapy (with or without chemotherapy) and surgical techniques such as total mesorectal excision. However, the contributions of surgery and radiotherapy to outcomes are unclear. We assessed the effect of the involvement of the circumferential resection margin and the plane of surgery achieved. METHODS: In this prospective study, the plane of surgery achieved and the involvement of the circumferential resection margin were assessed by local pathologists, using a standard pathological protocol in 1156 patients with operable rectal cancer from the CR07 and NCIC-CTG CO16 trial, which compared short-course (5 days) preoperative radiotherapy and selective postoperative chemoradiotherapy, between March, 1998, and August, 2005. All analyses were by intention to treat. This trial is registered, number ISRCTN 28785842. FINDINGS: 128 patients (11%) had involvement of the circumferential resection margin, and the plane of surgery achieved was classified as good (mesorectal) in 604 (52%), intermediate (intramesorectal) in 398 (34%), and poor (muscularis propria plane) in 154 (13%). We found that both a negative circumferential resection margin and a superior plane of surgery achieved were associated with low local recurrence rates. Hazard ratio (HR) was 0·32 (95% CI 0·16–0·63, p=0·0011) with 3-year local recurrence rates of 6% (5–8%) and 17% (10–26%) for patients who were negative and positive for circumferential resection margin, respectively. For plane of surgery achieved, HRs for mesorectal and intramesorectal groups compared with the muscularis propria group were 0·32 (0·16–0·64) and 0·48 (0·25–0·93), respectively. At 3 years, the estimated local recurrence rates were 4% (3–6%) for mesorectal, 7% (5–11%) for intramesorectal, and 13% (8–21%) for muscularis propria groups. The benefit of short-course preoperative radiotherapy did not differ in the three plane of surgery groups (p=0·30 for trend). Patients in the short-course preoperative radiotherapy group who had a resection in the mesorectal plane had a 3-year local recurrence rate of only 1%. INTERPRETATION: In rectal cancer, the plane of surgery achieved is an important prognostic factor for local recurrence. Short-course preoperative radiotherapy reduced the rate of local recurrence for all three plane of surgery groups, almost abolishing local recurrence in short-course preoperative radiotherapy patients who had a resection in the mesorectal plane. The plane of surgery achieved should therefore be assessed and reported routinely. FUNDING: Medical Research Council (UK) and the National Cancer Institute of Canada.
format Text
id pubmed-2668948
institution National Center for Biotechnology Information
language English
publishDate 2009
publisher Lancet Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-26689482009-04-17 Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial Quirke, Phil Steele, Robert Monson, John Grieve, Robert Khanna, Subhash Couture, Jean O'Callaghan, Chris Myint, Arthur Sun Bessell, Eric Thompson, Lindsay C Parmar, Mahesh Stephens, Richard J Sebag-Montefiore, David Lancet Articles BACKGROUND: Local recurrence rates in operable rectal cancer are improved by radiotherapy (with or without chemotherapy) and surgical techniques such as total mesorectal excision. However, the contributions of surgery and radiotherapy to outcomes are unclear. We assessed the effect of the involvement of the circumferential resection margin and the plane of surgery achieved. METHODS: In this prospective study, the plane of surgery achieved and the involvement of the circumferential resection margin were assessed by local pathologists, using a standard pathological protocol in 1156 patients with operable rectal cancer from the CR07 and NCIC-CTG CO16 trial, which compared short-course (5 days) preoperative radiotherapy and selective postoperative chemoradiotherapy, between March, 1998, and August, 2005. All analyses were by intention to treat. This trial is registered, number ISRCTN 28785842. FINDINGS: 128 patients (11%) had involvement of the circumferential resection margin, and the plane of surgery achieved was classified as good (mesorectal) in 604 (52%), intermediate (intramesorectal) in 398 (34%), and poor (muscularis propria plane) in 154 (13%). We found that both a negative circumferential resection margin and a superior plane of surgery achieved were associated with low local recurrence rates. Hazard ratio (HR) was 0·32 (95% CI 0·16–0·63, p=0·0011) with 3-year local recurrence rates of 6% (5–8%) and 17% (10–26%) for patients who were negative and positive for circumferential resection margin, respectively. For plane of surgery achieved, HRs for mesorectal and intramesorectal groups compared with the muscularis propria group were 0·32 (0·16–0·64) and 0·48 (0·25–0·93), respectively. At 3 years, the estimated local recurrence rates were 4% (3–6%) for mesorectal, 7% (5–11%) for intramesorectal, and 13% (8–21%) for muscularis propria groups. The benefit of short-course preoperative radiotherapy did not differ in the three plane of surgery groups (p=0·30 for trend). Patients in the short-course preoperative radiotherapy group who had a resection in the mesorectal plane had a 3-year local recurrence rate of only 1%. INTERPRETATION: In rectal cancer, the plane of surgery achieved is an important prognostic factor for local recurrence. Short-course preoperative radiotherapy reduced the rate of local recurrence for all three plane of surgery groups, almost abolishing local recurrence in short-course preoperative radiotherapy patients who had a resection in the mesorectal plane. The plane of surgery achieved should therefore be assessed and reported routinely. FUNDING: Medical Research Council (UK) and the National Cancer Institute of Canada. Lancet Publishing Group 2009-03-07 /pmc/articles/PMC2668948/ /pubmed/19269520 http://dx.doi.org/10.1016/S0140-6736(09)60485-2 Text en © 2009 Elsevier Ltd. All rights reserved. This document may be redistributed and reused, subject to certain conditions (http://www.elsevier.com/wps/find/authorsview.authors/supplementalterms1.0) .
spellingShingle Articles
Quirke, Phil
Steele, Robert
Monson, John
Grieve, Robert
Khanna, Subhash
Couture, Jean
O'Callaghan, Chris
Myint, Arthur Sun
Bessell, Eric
Thompson, Lindsay C
Parmar, Mahesh
Stephens, Richard J
Sebag-Montefiore, David
Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial
title Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial
title_full Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial
title_fullStr Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial
title_full_unstemmed Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial
title_short Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial
title_sort effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the mrc cr07 and ncic-ctg co16 randomised clinical trial
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2668948/
https://www.ncbi.nlm.nih.gov/pubmed/19269520
http://dx.doi.org/10.1016/S0140-6736(09)60485-2
work_keys_str_mv AT quirkephil effectoftheplaneofsurgeryachievedonlocalrecurrenceinpatientswithoperablerectalcanceraprospectivestudyusingdatafromthemrccr07andncicctgco16randomisedclinicaltrial
AT steelerobert effectoftheplaneofsurgeryachievedonlocalrecurrenceinpatientswithoperablerectalcanceraprospectivestudyusingdatafromthemrccr07andncicctgco16randomisedclinicaltrial
AT monsonjohn effectoftheplaneofsurgeryachievedonlocalrecurrenceinpatientswithoperablerectalcanceraprospectivestudyusingdatafromthemrccr07andncicctgco16randomisedclinicaltrial
AT grieverobert effectoftheplaneofsurgeryachievedonlocalrecurrenceinpatientswithoperablerectalcanceraprospectivestudyusingdatafromthemrccr07andncicctgco16randomisedclinicaltrial
AT khannasubhash effectoftheplaneofsurgeryachievedonlocalrecurrenceinpatientswithoperablerectalcanceraprospectivestudyusingdatafromthemrccr07andncicctgco16randomisedclinicaltrial
AT couturejean effectoftheplaneofsurgeryachievedonlocalrecurrenceinpatientswithoperablerectalcanceraprospectivestudyusingdatafromthemrccr07andncicctgco16randomisedclinicaltrial
AT ocallaghanchris effectoftheplaneofsurgeryachievedonlocalrecurrenceinpatientswithoperablerectalcanceraprospectivestudyusingdatafromthemrccr07andncicctgco16randomisedclinicaltrial
AT myintarthursun effectoftheplaneofsurgeryachievedonlocalrecurrenceinpatientswithoperablerectalcanceraprospectivestudyusingdatafromthemrccr07andncicctgco16randomisedclinicaltrial
AT besselleric effectoftheplaneofsurgeryachievedonlocalrecurrenceinpatientswithoperablerectalcanceraprospectivestudyusingdatafromthemrccr07andncicctgco16randomisedclinicaltrial
AT thompsonlindsayc effectoftheplaneofsurgeryachievedonlocalrecurrenceinpatientswithoperablerectalcanceraprospectivestudyusingdatafromthemrccr07andncicctgco16randomisedclinicaltrial
AT parmarmahesh effectoftheplaneofsurgeryachievedonlocalrecurrenceinpatientswithoperablerectalcanceraprospectivestudyusingdatafromthemrccr07andncicctgco16randomisedclinicaltrial
AT stephensrichardj effectoftheplaneofsurgeryachievedonlocalrecurrenceinpatientswithoperablerectalcanceraprospectivestudyusingdatafromthemrccr07andncicctgco16randomisedclinicaltrial
AT sebagmontefioredavid effectoftheplaneofsurgeryachievedonlocalrecurrenceinpatientswithoperablerectalcanceraprospectivestudyusingdatafromthemrccr07andncicctgco16randomisedclinicaltrial
AT effectoftheplaneofsurgeryachievedonlocalrecurrenceinpatientswithoperablerectalcanceraprospectivestudyusingdatafromthemrccr07andncicctgco16randomisedclinicaltrial
AT effectoftheplaneofsurgeryachievedonlocalrecurrenceinpatientswithoperablerectalcanceraprospectivestudyusingdatafromthemrccr07andncicctgco16randomisedclinicaltrial