EP581 - Assessing the Relative Impact of Adverse Features on Oncologic Outcomes in Rectal Cancer Surgery

Sunday, May 11, 2025

3:55 PM – 4:00 PM PT

Location: Monitor 6, Sails Pavilion, Upper Level

ePoster Presenter(s)

ES

Emily F. Simon, MD (she/her/hers)

General Surgery Resident
University Hospitals Cleveland Medical Center, Department of Surgery
Cleveland, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Kamil Erozkan, MD

Research Fellow
University Hospitals Cleveland Medical Center, Department of Surgery, Division of Colorectal
Cleveland, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
SK

Saher-Zahra Khan, MD

General Surgery Resident
University Hospitals Cleveland Medical Center
South Euclid, Ohio, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Kristen Westfall, MD, MPH (she/her/hers)

Colorectal Surgery Fellow
University Hospitals
Trinity Health Ann Arbor
Cleveland, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Ronald Charles, MD (he/him/his)

Assistant Professor of Surgery
University Hospitals Cleveland Medical Center, Department of Surgery, Division of Colorectal
Cleveland, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
ML

Melissa A. Lumish, MD

Assistant Professor
University Hospitals Cleveland Medical Center
Cleveland, Ohio, United States

Disclosure information not submitted.
JW

Joseph Willis, MD

Pathologist
Cleveland Medical center
Cleveland, Ohio, United States

Disclosure information not submitted.

Senior Author(s)

ES

Emily Steinhagen, MD, FACS, FASCRS

Associate Professor of Surgery
University Hospitals Cleveland Medical Center, Department of Surgery, Division of Colorectal
Cleveland, Ohio, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Emily F. Simon, MD: This individual has no financial relationships with ineligible companies.

Kamil Erozkan, MD: This individual has no financial relationships with ineligible companies.

Saher-Zahra Khan, MD: This individual has no financial relationships with ineligible companies.

Kristen Westfall, MD, MPH: This individual has no financial relationships with ineligible companies.

Ronald Charles, MD: This individual has no financial relationships with ineligible companies.

Emily Steinhagen, MD, FACS, FASCRS: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Outcomes for rectal cancer requiring resection reflect an intersection of tumor biology and technical operative consideration. However, the relative impact of each adverse prognostic feature is not well defined. For example, pathologic stage and presence of lymphovascular (LVI) or perineural invasion (PNI) as well as surgical margins and adequate nodal resection all impact outcomes. The current study aims to describe the magnitude of impact that tumor and operative factors have on recurrence and mortality after surgery.

Methods/Interventions: We retrospectively reviewed stage I-III rectal cancer patients who underwent elective resection at a single institution between 2019-2024. Univariate analysis compared demographics, preoperative treatment, surgical type and approach and pathologic factors between patients who recurred and those who did not. A multivariable logistic regression model predicting recurrence was performed using LVI, PNI, pathologic T and N stage (pT&N), adequate lymph node yield, circumferential radial (CRM) and distal margin, CEA and Total Mesorectal Excision (TME) grade as factors. Multivariate Cox regression was performed to assess survival using demographics, surgical pathologic findings and development of recurrence.

Results/Outcomes: 246 patients were included in the analysis, 47 (19.1%) of whom developed recurrence (6 local, 32 distant, 9 both). 29 (11.8%) patients died during the study period, of which 15 had recurred at time of death. Patients with recurrence were similar to nonrecurring patients in regards to sex, age, race, preoperative treatment (long or short course radiation; consolidation or induction chemotherapy), tumor location, sphincter involvement and months to last follow up. More patients with recurrence had clinical T3 disease (74.5% vs. 46.8%; p< 0.01) and proficient MMR status (95.7% vs. 84.3%; p=0.04). Regarding surgical pathology, patients had similar pT stage, tumor regression grades, tumor size, and proximal and distal margin length. Patients with recurrence had significantly higher rates of nodal disease (42.6% vs. 27.3%; p=0.04), LVI (43.5% vs. 24.2%; p< 0.01), PNI (28.3% vs. 15.7%; p=0.05) and positive CRM (23.4% vs. 4.1%; p< 0.001) with a trend towards lower rates of complete TME (82.6% vs. 92.1%; p=0.051). Operative approach (laparoscopic, robotic, open), surgical procedure (low anterior resection, abdominoperineal resection, etc.) and lymph node yield did not differ between groups.

On multivariable logistic regression, positive CRM led to the greatest odds of recurrence (OR 4.86; CI 1.51-15.62) followed by LVI (OR 2.29; CI 1.02-5.15). PNI, pT&N stage, nodal yield, positive distal resection margin, CEA, MMR status and TME grade did not significantly impact odds of recurrence. PNI (HR 6.79; CI 2.26-20.35) and developing recurrence (HR 3.87; CI 1.67-8.97) were associated with mortality, while positive CRM, LVI, pT&N stage, and TME grade were not.

Conclusion/Discussion: Appropriate surgical resection is paramount in minimizing a patient’s risk of disease recurrence compared to histopathologic features, as positive CRM is the strongest predictor of recurrence, irrespective of tumor biology including LVI, PNI, and tumor stage. In addition to developing recurrence, presence of PNI on surgical pathology was strongly associated with mortality.