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Related Experiment Video

Updated: Jun 22, 2026

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
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Benchmarking circumferential resection margin (R1) resection rate for rectal cancer in the neoadjuvant era.

W Chambers1, G Collins, B Warren

  • 1Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, UK.

Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland
|June 11, 2009
PubMed
Summary

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Predictors of positive circumferential resection margin (CRM) in rectal cancer surgery were identified. Total mesorectal excision (TME) defects and preoperative imaging predicting CRM involvement are key factors, not solely surgical quality.

Area of Science:

  • Oncology
  • Surgical Pathology
  • Medical Auditing

Background:

  • Circumferential resection margin (CRM) involvement (R1) is a key indicator for auditing rectal cancer surgical quality.
  • Downsizing chemoradiation (dCRT) complicates R1 audits, as it assesses both dCRT effectiveness and surgical quality.
  • Locally advanced tumors are common in the dCRT era, necessitating a nuanced approach to R1 assessment.

Purpose of the Study:

  • To identify predictors of R1 resection in rectal cancer.
  • To benchmark R1 rates within the context of dCRT.
  • To evaluate the impact of multidisciplinary team (MDT) process failures on CRM involvement.

Main Methods:

  • Retrospective analysis of prospectively collected rectal cancer data.
  • Classification of patients based on CRM status.

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  • Univariate and multivariate analysis to identify risk factors for R1 resection.
  • Assessment of MDT process steps contributing to CRM involvement.

    • Main Results:

    • R1 and R2 resections occurred in 10% and 3% of 210 evaluated rectal cancers, respectively.
    • Total mesorectal excision (TME) specimen defects and preoperative imaging predicting CRM involvement were independent predictors of R1 resection.
    • Less than half of R1 failures were associated with MDT steps, and only 15% were solely due to suboptimal TME specimens.

    Conclusions:

    • TME specimen integrity and preoperative CRM status are strong predictors of R1 resection.
    • The TME specimen was intact in most R1 resections, indicating factors beyond surgical technique contribute.
    • R1 rates should consider local staging and dCRT effectiveness when evaluating surgical competence.