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R1 rectal resection: look up and don't look down
Camille Tilly1, Jérémie H Lefèvre, Magali Svrcek
1*Department of Digestive Surgery †Department of Pathology, Hôpital Saint-Antoine, Assistance-Publique/Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
Annals of Surgery
|November 8, 2014
Summary
R1 resection after rectal cancer surgery is linked to poorer survival and more distant recurrences compared to R0 resection. This highlights the need for chemotherapy and thoracic surveillance in R1 cases.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Gastrointestinal Pathology
Background:
- Rectal resection for adenocarcinoma can result in R1 resection if margins (distal, tumor, or nodal) are invaded (≤1 mm).
- R1 resection signifies a deviation from the intended R0 (complete) resection, impacting oncological outcomes.
Purpose of the Study:
- To evaluate the prognostic implications of R1 resection in rectal adenocarcinoma.
- To compare recurrence rates (local vs. distant) between R1 and R0 resections.
- To inform adjuvant treatment strategies following R1 rectal resection.
Main Methods:
- Retrospective analysis of R1 rectal resections between 2006-2011.
- Matching R1 patients (n=40) with R0 patients (n=80) based on key clinical and pathological factors.
- Comparative analysis of overall survival (OS), disease-free survival (DFS), and recurrence patterns.
Main Results:
- R1 resection occurred in 8.5% of cases, primarily due to tumor (CRM-T) or nodal (CRM-N) involvement.
- R1 resections showed a trend towards worse OS (62% vs. 79%) and significantly worse DFS (41% vs. 65%) compared to R0.
- Local recurrence rates were similar (12% vs. 13%), but distant recurrence was significantly higher after R1 resection (56% vs. 26%).
Conclusions:
- R1 resection is associated with a poorer prognosis in rectal cancer compared to R0 resection.
- While local recurrence rates are comparable, R1 resection significantly increases the risk of distant recurrence, particularly to the lungs.
- Adjuvant chemotherapy and vigilant thoracic surveillance are recommended for patients with R1 rectal resection.