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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
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.
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.
