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Background and objectives: There is ongoing debate on criteria for the definition of a positive resection margin after radical surgery for rectal cancer. It is generally accepted that in order for R0 resection to be obtained, surgical margins should be greater than 1 mm. The aim of this study is to investigate the impact of threatened resection margins on the oncologic outcome of patients, with a focus on local, regional and metastatic recurrence rates, overall survival rates and recurrences-free survival rates in n on metastatic patients treated for rectal adenocarcinoma by curative total mesorectal excision. Patients and methods: We identified a sample of 163 patients who underwent curative total mesorectal excision for rectal adenocarcinoma in Cliniques Universitaires Saint-Luc in Brussels between 2005 and 2015. We studied local, regional and metastatic recurrence rates, overall survival and recurrence-free survival rates. We compared these outcome parameters in patients with pathological distal margins of < 1 mm, with a control whose margins were greater than 1 mm. Results: Our study included a total of 163 patients (105 male, 58 female). Patients were divided in 4 groups according to their pathological distal margins. 152 (93, 3%) patients had large margins. 5 (3, 1%) patients had margins of 1 mm (limit margins), and 1 (0, 6%) patient had margins of < 1mm (invaded margins). 5 (3, 1%) patients had unknown pathological distal margins. Median age for all patients on the date of surgery was of 67, 1 years. 129 (79, 1%) of our patients underwent neo adjuvant treatment, which consisted in radio-chemotherapy in 115 (70, 6%) cases and radiotherapy alone in 14 (8, 6 %) cases. 92 (56, 4%) patients underwent adjuvant treatment after surgery. Most patients were staged Ct3 (119, 73 %) CN1 (72, 44, 2%), Cm0 (142, 87, 1%). Proportionally to the size of the group, tumors were more advanced in the limit margin group. Regarding recurrence rates, 26 (16, 0%) patients relapsed. Relapse was metastatic in 23 (14, 1%) patients, regional in 5 (3, 1%) patients, and local in 3 (1, 8%) patients. The patient with an invaded margin did not present any kind of relapse. In the limit margin group, 2 patients (40, 0%) suffered metastatic relapse. In the large margin group 20 patients (13, 2 %) presented metastatic relapse. Recurrence-free 5-years survival rates were not estimable due to the lack of sufficient events. Overall 5-years survival was 100% for the limit margin, invaded margin, unknown margin group, 79, 9% for the large margin group, and 81, 2 % all group considered. Conclusion: Our results showed that recurrence was more frequent in the limit margin group. This could indicate that the larger the surgical margin, the lower the recurrence rate, which is a result we expected to find. However, relapse in this group was metastatic, which was surprising as we expected to observe more cases of local. Due to the small number of patients in the limit margin and invaded margin groups, and the important imbalance in numbers, we were not able to make statistical comparison between the groups.

Retrospective Studies --- Treatment Outcome --- Adenocarcinoma --- Colorectal Surgery --- Margins of Excision

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Fatty Acids, Omega-3 --- Neoplasms --- Treatment Outcome. --- physiology. --- prevention & control.

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Arthritis, Rheumatoid --- Cohort Studies --- Prognosis --- Treatment Outcome --- drug therapy

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Manipulation, Spinal --- Neck Pain --- Musculoskeletal Manipulations --- Treatment Outcome --- methods --- therapy

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Fatty Acids, Omega-3 --- Neoplasms --- Treatment Outcome. --- physiology. --- prevention & control.