Risk Factors Associated With Circumferential Resection Margin Positivity in Rectal Cancer: A Binational Registry Study

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BACKGROUND:Rectal cancer outcomes have improved with the adoption of a multidisciplinary model of care. However, there is a spectrum of quality when viewed from a national perspective, as highlighted by the Consortium for Optimizing the Treatment of Rectal Cancer data on rectal cancer care in the United States.OBJECTIVE:The aim of this study was to assess and identify predictors of circumferential resection margin involvement for rectal cancer across Australasia.DESIGN:A retrospective study from a prospectively maintained binational colorectal cancer database was interrogated.SETTINGS:This study is based on a binational colorectal cancer audit database.PATIENTS:Clinical information on all consecutive resected rectal cancer cases recorded in the registry from 2007 to 2016 was retrieved, collated, and analyzed.MAIN OUTCOME MEASURES:The primary outcome measure was positive circumferential resection margin, measured as a resection margin ≤1 mm.RESULTS:A total of 3367 patients were included, with 261 (7.5%) having a positive circumferential resection margin. After adjusting for hospital and surgeon volume, hierarchical logistic regression analysis identified a 6-variable model encompassing the independent predictors, including urgent operation, abdominoperineal resection, open technique, low rectal cancer, T3 to T4, and N1 to N2. The accuracy of the model was 92.3%, with an receiver operating characteristic of 0.783 (p < 0.0001). The quantitative risk associated with circumferential resection margin positivity ranged from <1% (no risk factors) to 43% (6 risk factors).LIMITATIONS:This study was limited by the lack of recorded long-term outcomes associated with circumferential resection margin positivity.CONCLUSIONS:The rate of circumferential resection margin involvement in patients undergoing rectal cancer resection in Australasia is low and is influenced by a number of factors. Risk stratification of outcome is important with the increasing demand for publicly accessible quality data. See Video Abstract at http://links.lww.com/DCR/A512.

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