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Risk Factors Associated With Circumferential Resection Margin Positivity in Rectal Cancer: A Binational Registry

Satish K Warrier, Joseph Cherng Kong, Glen R Guerra

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The rate of positive circumferential resection margins in rectal cancer surgery in Australasia is low (7.5%). Key predictors include urgent operations, specific surgical techniques, and advanced tumor stage, aiding risk stratification for better rectal cancer care.

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Area of Science:

  • Oncology
  • Surgical Pathology
  • Public Health

Background:

  • Multidisciplinary care has improved rectal cancer outcomes.
  • National quality of care varies, as indicated by US data.
  • Assessing quality metrics like margin involvement is crucial.

Purpose of the Study:

  • To evaluate the rate of positive circumferential resection margin (CRM) in rectal cancer surgery across Australasia.
  • To identify independent predictors associated with CRM involvement.
  • To develop a risk stratification model for CRM positivity.

Main Methods:

  • Retrospective analysis of a prospectively maintained binational colorectal cancer database (2007-2016).
  • Inclusion of all consecutive resected rectal cancer cases.
  • Primary outcome: positive CRM (resection margin ≤1 mm).

Main Results:

  • 3367 patients analyzed; 7.5% had positive CRM.
  • A 6-variable model identified predictors: urgent operation, abdominoperineal resection, open technique, low rectal cancer, T3-T4, and N1-N2.
  • The model demonstrated 92.3% accuracy (AUROC 0.783).
  • Risk of positive CRM ranged from <1% to 43% based on risk factors.

Conclusions:

  • CRM involvement in Australasian rectal cancer resections is infrequent.
  • Predictive factors identified allow for risk stratification.
  • Further research should incorporate long-term outcomes related to CRM positivity.