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Variation in circumferential resection margin: Reporting and involvement in the South-Netherlands
J Homan1, G M Bökkerink1, M J Aarts2
1Department of Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
Summary
Reporting of the circumferential resection margin (CRM) in rectal cancer surgery has improved, with CRM involvement decreasing significantly. Neoadjuvant treatments reduced CRM involvement, while T4-stage cancer increased the risk.
Area of Science:
- Oncology
- Surgical Pathology
- Cancer Research
Background:
- Total mesorectal surgery has improved rectal cancer outcomes.
- Circumferential resection margin (CRM) involvement predicts poor prognosis.
- Abdomino perineal excision (APE) carries a higher risk of CRM involvement.
Purpose of the Study:
- To analyze CRM reporting in rectal cancer surgery.
- To identify predictive factors for CRM involvement.
- To assess changes in CRM reporting and involvement over time.
Main Methods:
- Utilized a population-based dataset of 2153 primary rectal cancer patients (2008-2013).
- Assessed variations in CRM reporting across pathology departments.
- Performed multivariate analyses to identify predictive factors for CRM involvement.
Main Results:
- CRM reporting improved from 77% to 90% between 2008 and 2012.
- CRM involvement decreased significantly from 12% to 6% during the study period.
- Clinical T4-stage cancer increased CRM involvement risk (OR=3.51); neoadjuvant radiotherapy/chemoradiation decreased risk (OR=0.39/0.30).
Conclusions:
- Despite improvements, variability in CRM reporting persists in the Southern Netherlands.
- Abdomino perineal excision (APE) was not associated with increased CRM involvement risk in multivariate analysis.
- Neoadjuvant therapy is a significant factor in reducing CRM involvement.