Investigation of circumferential resection margin in rectal cancer surgery

Abstract

Purpose: Literature data suggest that investigation of the circumferential resection margin (CRM) in rectal cancer surgery gives significant information for prognosis of the disease and the quality of the performed operation. The aim of this study was to analyze the clinical and morphological aspects of CRM in pT3 tumors in relation to their significance for rectal cancer treatment and staging.

Patients and methods: Thirty patients with radically operated pT3 stage rectal cancer were investigated. The resected specimens were studied both macroscopically and microscopically to assess CRM and the quality of the performed operation.

Results: Six (20%) patients had positive CRM (CRM +; tumor cells in the margin or < 1 mm from it). These cases were characterized with deep infiltration (> 4 mm) in the rectal adventitia (perirectal tissue). Statistically significant correlation was found between CRM status and quality of the resected specimen (including the presence of rectal fascia in CRM). There was no correlation between pathological characteristics of the tumor and the status of CRM.

Conclusion: The status of CRM is a factor independent from TNM classification. The presence of rectal fascia in CRM confirms the good quality of the operation. CRM+ could be a result of inadequate surgery or advanced disease. The status of CRM could be used in the decision-making for postoperative adjuvant treatment.