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dc.contributor.authorSimillis, C
dc.contributor.authorBaird, DLH
dc.contributor.authorKontovounisios, C
dc.contributor.authorPawa, N
dc.contributor.authorBrown, G
dc.contributor.authorRasheed, S
dc.contributor.authorTekkis, PP
dc.date.accessioned2018-02-19T10:03:41Z
dc.date.issued2017-02
dc.identifier.citationAnnals of surgery, 2017, 265 (2), pp. 291 - 299
dc.identifier.issn0003-4932
dc.identifier.urihttps://repository.icr.ac.uk/handle/internal/1254
dc.identifier.eissn1528-1140
dc.identifier.doi10.1097/sla.0000000000001963
dc.description.abstractObjective The aim of this study was to assess resection margin status and its impact on survival after abdominoperineal excision and pelvic exenteration for primary or recurrent rectal cancer.Summary of background data Resection margin is important to guide therapy and to evaluate patient prognosis.Methods A meta-analysis was performed to assess the impact of resection margin status on survival, and a regression analysis to analyze positive resection margin rates reported in the literature.Results The analysis included 111 studies reporting on 19,607 participants after abdominoperineal excision, and 30 studies reporting on 1326 participants after pelvic exenteration. The positive resection margin rates for abdominoperineal excision were 14.7% and 24.0% for pelvic exenteration. The overall survival and disease-free survival rates were significantly worse for patients with positive compared with negative resection margins after abdominoperineal excision [hazard ratio (HR) 2.64, P < 0.01; HR 3.70, P < 0.01, respectively] and after pelvic exenteration (HR 2.23, P < 0.01; HR 2.93, P < 0.01, respectively). For patients undergoing abdominoperineal excision with positive resection margins, the reported tumor sites were 57% anterior, 15% posterior, 10% left or right lateral, 8% circumferential, 10% unspecified. A significant decrease in positive resection margin rates was identified over time for abdominoperineal excision. Although positive resection margin rates did not significantly change with the size of the study, some small size studies reported higher than expected positive resection margin rates.Conclusions Resection margin status influences survival and a multidisciplinary approach in experienced centers may result in reduced positive resection margins. For advanced anterior rectal cancer, posterior pelvic exenteration instead of abdominoperineal excision may improve resection margins.
dc.formatPrint
dc.format.extent291 - 299
dc.languageeng
dc.language.isoeng
dc.subjectAbdomen
dc.subjectPerineum
dc.subjectRectum
dc.subjectHumans
dc.subjectRectal Neoplasms
dc.subjectTreatment Outcome
dc.subjectPelvic Exenteration
dc.subjectSurvival Analysis
dc.subjectMargins of Excision
dc.titleA Systematic Review to Assess Resection Margin Status After Abdominoperineal Excision and Pelvic Exenteration for Rectal Cancer.
dc.typeJournal Article
rioxxterms.versionofrecord10.1097/sla.0000000000001963
rioxxterms.licenseref.startdate2017-02
rioxxterms.typeJournal Article/Review
dc.relation.isPartOfAnnals of surgery
pubs.issue2
pubs.notesNot known
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.publication-statusPublished
pubs.volume265
pubs.embargo.termsNot known
dc.contributor.icrauthorMarsden,en


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