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Abstract
We performed a multivariate analysis of survival data from 278 patients who underwent
potentially curative anterior resection with hand-sewn anastomosis for nonobstructing
colorectal carcinoma to evaluate the interaction of the resection margin with distance
from the anal verge and their contributions to local and distant recurrence. Cumulative
5-year disease-free survival was 66 percent for the 258 patients with complete follow-up.
Forty-nine patients (19 percent) had local recurrence and 42 (16 percent) developed
initial distant metastases. Local recurrence rates increased with increasing age and
with more advanced Dukes' stage. It developed in twice as many patients with colostomies
as without colostomies. Distant metastases developed significantly more often in patients
with nodal involvement and in patients with resection margins exceeding 3.5 cm. Forty-four
percent of patients with lesions within 14 cm of the anal verge resected with margins
of at least 3.5 cm developed distant recurrence. This study suggests that aggressive
pelvic dissection to achieve resection margins greater than 3.5 cm may contribute
to tumor dissemination and subsequent distant metastases.
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© 1989 Published by Elsevier Inc.
