American journal of surgery · 2026
High rates of positive circumferential resection margins after abdominoperineal resection for rectal cancer: Predictors and time trends.
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Rudasill Sarah E, Tang Rebecca B, Alahmadi Sami, Cauley Christy E, Goldstone Robert N, Kunitake Hiroko, Ricciardi Rocco, Lee Grace C
Аннотация
BACKGROUND: Circumferential resection margin (CRM) positivity predicts recurrence after abdominoperineal resection (APR) for rectal cancer, yet preoperative risk factors remain poorly defined.
METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program's proctectomy database (2016-2023), we analyzed adults undergoing elective APR for non-metastatic rectal cancer, stratified by CRM status. Univariate and multivariable analyses identified preoperative predictors of CRM positivity.
RESULTS: Of 5497 patients, 10.6% had CRM+, with rates rising from 8.1% to 13.6% over the study period (p < 0.001). Independent predictors of CRM + included male sex (OR = 1.56, p < 0.001), open approach (OR = 1.47, p < 0.001), clinical T4 (OR = 2.58, p = 0.003) and N2 disease (OR = 2.74, p < 0.001), multivisceral resection (OR = 1.50, p = 0.021), and hypoalbuminemia (OR = 1.75, p < 0.001). Preoperative radiation within 90 days was protective (OR = 0.47, p < 0.001).
CONCLUSION: These preoperative risk factors for CRM + after APR can guide risk stratification, patient counseling, and consideration of intraoperative frozen sections in high-risk cases.
METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program's proctectomy database (2016-2023), we analyzed adults undergoing elective APR for non-metastatic rectal cancer, stratified by CRM status. Univariate and multivariable analyses identified preoperative predictors of CRM positivity.
RESULTS: Of 5497 patients, 10.6% had CRM+, with rates rising from 8.1% to 13.6% over the study period (p < 0.001). Independent predictors of CRM + included male sex (OR = 1.56, p < 0.001), open approach (OR = 1.47, p < 0.001), clinical T4 (OR = 2.58, p = 0.003) and N2 disease (OR = 2.74, p < 0.001), multivisceral resection (OR = 1.50, p = 0.021), and hypoalbuminemia (OR = 1.75, p < 0.001). Preoperative radiation within 90 days was protective (OR = 0.47, p < 0.001).
CONCLUSION: These preoperative risk factors for CRM + after APR can guide risk stratification, patient counseling, and consideration of intraoperative frozen sections in high-risk cases.