The circumferential margin in rectal cancer. Recommendations based on the Dutch Total Mesorectal Excision Study

A very low local recurrence rate in rectal cancer is possible with optimal staging, preoperative radiotherapy and the use of total mesorectal excision (TME). Data from a study where patients were randomised for preoperative radiotherapy (or not) and complete removal of the tumour and mesorectum were examined. A consensus meeting was held to discuss the data in which the following guidelines for implementation were made. Adequate imaging is necessary to increase the likelihood of a R0 resection. Advances cases (possible margin to the endopelvicfascie less than 2 mm) need a long course of preoperative radiotherapy. Primary resectable cases benefit from a short course of radiation directly followed by surgery. A continuous quality control of surgery is mandatory in order to maintain the skill for a TME. A complete pathology report is important for the quality control of the surgical treatment and to predict the outcome of treatment. All of the involved disciplines in the diagnosis and treatment of rectal cancer should focus on the circumferential margin to guide for optimal treatment. Multidisciplinary teams are important for the achievement of optimal treatment planning of rectal cancer patients and maintenance of the highest level of quality control.