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Updated: Jul 4, 2025

Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
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Development of a Predictive Nomogram for Circumferential Resection Margin in Rectal Cancer Surgery.

Megan Shroder1, Molly M Ford1, Fei Ye2

  • 1Division of General Surgery, Section of Colon & Rectal Surgery, Vanderbilt University, Nashville, Tennessee.

The Journal of Surgical Research
|February 9, 2024
PubMed
Summary

A nomogram was developed to predict positive circumferential resection margins (CRM) in rectal cancer patients. This tool identifies high-risk individuals preoperatively, aiding in surgical planning and improving outcomes.

Keywords:
Colorectal surgeryRectal cancerSurgical oncology

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Area of Science:

  • Oncology
  • Surgical Quality Metrics

Background:

  • Circumferential resection margin (CRM) status is crucial for rectal cancer prognosis and survival.
  • Accurate preoperative identification of positive CRM is essential for optimal treatment planning.

Purpose of the Study:

  • To develop a predictive nomogram for identifying patients at risk of positive CRM before surgery.
  • To enhance preoperative assessment for rectal cancer patients undergoing total mesorectal excision.

Main Methods:

  • Retrospective analysis of the National Cancer Database (2010-2014).
  • Inclusion of clinical stage I-III rectal cancer patients undergoing total mesorectal excision.
  • Exclusion criteria: emergency operations, recurrence resection, palliative resection, transanal resection, and missing CRM status.

Main Results:

  • A total of 28,790 patients were analyzed; 7.8% had a positive CRM.
  • Factors significantly associated with positive CRM included higher tumor grade, lack of neoadjuvant chemotherapy, specific histology, open approach, abdominoperineal resection, advanced T stage, lymphovascular invasion, and perineural invasion.
  • The developed nomogram demonstrated good predictive accuracy with a C-statistic of 0.703.

Conclusions:

  • Positive CRM in rectal cancer is linked to distinct patient and tumor characteristics.
  • These identified factors, combined with preoperative MRI, can effectively predict CRM positivity.
  • Preoperative prediction facilitates tailored surgical planning and potentially improves oncologic outcomes.