Distinct prognostic impact of circumferential resection margin and adverse histologic features after intersphincteric resection for ultra-low rectal cancer following chemoradiotherapy: a retrospective cohort study.
- 1Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Abstract
Purpose
Circumferential resection margin (CRM) involvement after intersphincteric resection (ISR) is uncommon but clinically important. We evaluated the association of CRM status and adverse histopathologic features with recurrence after ISR following neoadjuvant concurrent chemoradiotherapy (CCRT).Methods
From 2011 to 2022, 520 patients underwent ISR for ultra-low rectal cancer (≤3 cm from the anal verge) at a single tertiary center. Among them, 326 who received CCRT were analyzed. Clinicopathologic variables were evaluated in relation to disease-free survival (DFS), local recurrence-free survival (LRFS), and distant recurrence-free survival (DRFS). Multivariable Cox regression evaluated adjusted associations.Results
CRM involvement occurred in 8 patients (2.5%). Fifty-four patients (16.6%) developed recurrence: 17 local only, 34 distant only, and 3 both. Five-year DFS, LRFS, DRFS, and overall survival were 74.8%, 87.5%, 85.5%, and 91.4%, respectively. CRM involvement was associated with inferior DFS (45.0% vs. 75.8%, P = 0.018) and LRFS (52.5% vs. 88.6%, P < 0.001), but not DRFS (72.9% vs. 85.8%, P = 0.299). After adjustment, CRM involvement remained associated with LRFS (hazard ratio [HR], 9.419; P < 0.001) and DFS (HR, 3.612; P = 0.017). Perineural invasion was associated with all recurrence endpoints.Conclusion
CRM involvement was associated predominantly with poorer local control after ISR following CCRT, whereas adverse microscopic features, particularly perineural invasion, showed broader associations with both local and distant recurrence. The combined assessment of CRM status and microscopic tumor invasiveness may therefore provide complementary prognostic information after ISR for ultra-low rectal cancer.
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BibTeX
@article{shin2026distinct,
title = {{Distinct prognostic impact of circumferential resection margin and adverse histologic features after intersphincteric resection for ultra-low rectal cancer following chemoradiotherapy: a retrospective cohort study.}},
author = {Jung Kyong Shin and Hee Cheol Kim and Woo Yong Lee and Seong Hyeon Yun and Yong Beom Cho and Jung Wook Huh and Yoon Ah Park},
journal = {Annals of surgical treatment and research},
year = {2026},
month = oct,
doi = {10.4174/astr.2026.111.4.227},
url = {https://europepmc.org/article/MED/42909225},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Distinct prognostic impact of circumferential resection margin and adverse histologic features after intersphincteric resection for ultra-low rectal cancer following chemoradiotherapy: a retrospective cohort study.
AU - Jung Kyong Shin
AU - Hee Cheol Kim
AU - Woo Yong Lee
AU - Seong Hyeon Yun
AU - Yong Beom Cho
AU - Jung Wook Huh
AU - Yoon Ah Park
PY - 2026
DA - 2026/10/08
JO - Annals of surgical treatment and research
DO - 10.4174/astr.2026.111.4.227
UR - https://europepmc.org/article/MED/42909225
AB - Purpose Circumferential resection margin (CRM) involvement after intersphincteric resection (ISR) is uncommon but clinically important. We evaluated the association of CRM status and adverse histopathologic features with recurrence after ISR following neoadjuvant concurrent chemoradiotherapy (CCRT).Methods From 2011 to 2022, 520 patients underwent ISR for ultra-low rectal cancer (≤3 cm from the anal verge) at a single tertiary center. Among them, 326 who received CCRT were analyzed. Clinicopathologic variables were evaluated in relation to disease-free survival (DFS), local recurrence-free survival (LRFS), and distant recurrence-free survival (DRFS). Multivariable Cox regression evaluated adjusted associations.Results CRM involvement occurred in 8 patients (2.5%). Fifty-four patients (16.6%) developed recurrence: 17 local only, 34 distant only, and 3 both. Five-year DFS, LRFS, DRFS, and overall survival were 74.8%, 87.5%, 85.5%, and 91.4%, respectively. CRM involvement was associated with inferior DFS (45.0% vs. 75.8%, P = 0.018) and LRFS (52.5% vs. 88.6%, P < 0.001), but not DRFS (72.9% vs. 85.8%, P = 0.299). After adjustment, CRM involvement remained associated with LRFS (hazard ratio [HR], 9.419; P < 0.001) and DFS (HR, 3.612; P = 0.017). Perineural invasion was associated with all recurrence endpoints.Conclusion CRM involvement was associated predominantly with poorer local control after ISR following CCRT, whereas adverse microscopic features, particularly perineural invasion, showed broader associations with both local and distant recurrence. The combined assessment of CRM status and microscopic tumor invasiveness may therefore provide complementary prognostic information after ISR for ultra-low rectal cancer.
SN - 2288-6575
SN - 2288-6796
ER -