Importance of surgical margins in rectal cancer

Krishnamurty, Devi Mukkai; Wise, Paul E.

doi:10.1002/jso.24136

Cited by 44 publications

(40 citation statements)

References 105 publications

(129 reference statements)

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“…In fact, clinical experience and the literatures tell us that lower rectal cancer is more likely to appear a DRM <1 cm, or even a positive DRM, which is related to the surgical technique and difficulty. 5 Distant metastasis is associated with N stage, but not T stage, which is also in line with our expectations. Of course, regardless of T or N stage, after correcting multiple factors, this is corrected by the more superior TNM stage.…”

Section: Discussionsupporting

confidence: 91%

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A negative‐doughnut distal resection margin less than 5 mm does not affect prognosis in rectal cancer

Keranmu

Liu

et al. 2018

Journal of Surgical Oncology

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AimMany issues relating to the distal margin of anterior resection of the rectum still exist. We aimed to investigate whether negative distal resection margin (DRM) and positive DRM in the main specimen with negative doughnut has equivalent prognosis in patients with rectal cancer.MethodsWe included 287 patients with rectal cancer, including 69 cases with positive margins and 218 cases with negative margins, all of whom underwent regular follow‐up. Survival rate was calculated using Kaplan‐Meier survival analysis, while the log‐rank test was used to determine statistical difference. Prognostic factors were found using the Cox regression model.ResultsThere was no significant difference in clinicopathological features between the two groups with the exception of tumor location. Positive findings in the DRM with negative findings in the doughnut resection do not affect the overall survival, local recurrence, or distant metastasis. Factors relating to resection margin, such as the length of resection, negative, or positive findings, were not found to be prognostic.ConclusionGiven postoperative pathology results with positive DRM but negative findings in the doughnut resection, a second surgery was not necessary. Instead, adjuvant radiochemotherapy and close follow‐up will suffice.

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Section: Discussionsupporting

confidence: 91%

“…The use of circular end-to-end staplers has revolutionized rectal surgery. 5 The use of this surgical instrument results in the resected specimen being divided into two parts. In addition to the main specimen, there is a "doughnut" with a resection margin of <5 mm.…”

mentioning

confidence: 99%

A negative‐doughnut distal resection margin less than 5 mm does not affect prognosis in rectal cancer

Keranmu

Liu

et al. 2018

Journal of Surgical Oncology

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“…Most studies demonstrated no significant difference in local recurrence with distal rectal margins greater than or less than 1 cm, particularly in conjunction with neoadjuvant therapy [21]. In contrast, an inadequate circumferential margin (less than 1-2 mm) was associated with increased risk of local recurrence and a decreased disease-specific survival rate [21]. …”

Section: Rectal Adenocarcinoma Versus Rectal/pelvic Leiomyosarcomamentioning

confidence: 99%

Tumor Biological Aspects of Epithelial versus Mesenchymal Tumors of the Gastrointestinal Tract

Raut

2018

Visc Med

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One of the holy grails of cancer surgery for surgical oncologists is to perform a macroscopically complete resection of the affected organ or site with negative microscopic margins. The surgical oncologist must also be mindful of what constitutes appropriately-sized negative margins. However, what is necessary, based on the best available evidence, can vary considerably for different malignancies arising within the same organ. This review compares two different gastric and rectal malignancies, one each of epithelial and of mesenchymal origin. Data supporting extent of margins will be reviewed, illustrating the importance of knowing the histologic diagnosis prior to surgery to provide proper oncologic care.

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“…The development of surgical techniques, stapling devices (staplers) and wide application of neoadjuvant chemotherapy and radiotherapy, this surgical procedure is increasingly giving way to previously described sphincter-preserving surgical procedures. However, it still serves as the method of choice for all patients diagnosed with T2-T4 rectal cancer where it is not possible to achieve tumor free distal margin of at least 1-2 cm, with locally advanced rectal cancer and low infiltration of the sphincter mechanism and / or rectovaginal septum, as well as those patients with poor preoperative function of the sphincter mechanism [15]. Abdominoperineal extirpation removes the rectum with tumor and anus (including total mesorectal excision and sphincter mechanism), and part of sigmoid colon, with the formation of a permanent terminal colostomy.…”

Section: Radical (Transabdominal) Operating Proceduresmentioning

confidence: 99%

Modern surgical treatment of rectal cancer

Zovak¹,

Bilic²,

Kopljar³

2017

Rad Hrvatske akademije znanosti i umjetnosti

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SummarySurgical treatment is a method of choice in treating patients with resectable primary form of rectal cancer. An important step in treatment is the multidisciplinary approach from different medical specialties in the fields of radiology, gastroenterology, oncology and surgery. In recent years, several minimally invasive surgical procedures have been developed that improve postoperative recovery while still preserving oncological principles, such as laparoscopic low anterior resection, transanal total mesorectal excision and robotic surgery. Surgical and oncological principles that must be respected in all cases are wide resection of the tumor with histologically free resection margins and the use of total mesorectal excision with anal sphincter preservation and preservation of the continuity of the intestine whenever possible.

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Importance of surgical margins in rectal cancer

Cited by 44 publications

References 105 publications

A negative‐doughnut distal resection margin less than 5 mm does not affect prognosis in rectal cancer

A negative‐doughnut distal resection margin less than 5 mm does not affect prognosis in rectal cancer

Tumor Biological Aspects of Epithelial versus Mesenchymal Tumors of the Gastrointestinal Tract

Modern surgical treatment of rectal cancer

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