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Circumferential resection margin as a prognostic factor in rectal cancer.

T E Bernstein¹, B H Endreseth, P Romundstad

¹Department of Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. tor.bernstein@stolav.no

The British Journal of Surgery

|October 23, 2009

Summary

A narrow circumferential resection margin (CRM) of 2 mm or less in rectal cancer patients indicates a poorer prognosis. Early consideration for neoadjuvant treatment is recommended for these individuals.

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Area of Science:

Oncology
Surgical Oncology
Rectal Cancer Research

Background:

Investigated the prognostic significance of the circumferential resection margin (CRM) in rectal cancer patients.
Focused on patients treated with total mesorectal excision (TME), with or without preoperative radiotherapy.

Purpose of the Study:

To determine the impact of CRM status on patient outcomes.
To identify specific tumor characteristics and treatment modalities influencing prognosis based on CRM.

Main Methods:

Utilized a national population-based registry of 3196 rectal cancer patients (1993-2004).
Included patients with known CRM status who underwent TME, excluding those with perforations or postoperative radiotherapy.
Analyzed outcomes for patients receiving surgery alone versus preoperative radiotherapy.

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Main Results:

A CRM of 0-2 mm was associated with significantly higher 5-year local recurrence (23.7%) and distant metastasis (43.9%) rates, and lower overall survival (44.5%) compared to wider margins.
CRM ≤ 2 mm impacted prognosis for T2/T3 tumors 6-15 cm above the anal verge, but not lower tumors.
Preoperative radiotherapy showed a prognostic impact on CRM, though with less precision.

Conclusions:

A CRM of 2 mm or less is a significant indicator of a poorer prognosis in rectal cancer.
Patients with a CRM of 2 mm or less should be considered for neoadjuvant treatment to improve outcomes.