High rates of positive circumferential resection margins after abdominoperineal resection for rectal cancer: Predictors and time trends.

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.