Positive circumferential resection margins following locally advanced colon cancer surgery: Risk factors and survival impact

Abstract

Background: While the prognostic implications of positive circumferential resection margins (CRM) have been established for rectal cancer, its significance in colon cancer has not been well defined. The aim of the current study was to determine national rates for positive CRM in locally advanced colon cancer, associated factors, and survival impact.Methods: The National Cancer Database was queried to identify patients with stage II-III adenocarcinoma of the colon (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015).Results: Positive CRM was identified in 9% of stage II and 12% of stage III patients.Factors associated with negative CRM included surgery in a high-volume facility, adequate lymph-node harvest, and negative distal/proximal margins. No difference in CRM rates was observed between surgical approaches, although having a positive CRM was significantly associated with higher conversion rates. Positive CRM was associated with significantly lower overall survival on both univariate and multivariable analysis.Conclusions: Positive CRM rates exceeded 10% nationally and have an adverse impact on survival. While several tumor characteristics were identified as independent risk factors, oncologic resections and surgery at high-volume centers were associated with lower rates of positive CRM. These findings emphasize the need for process improvement initiatives targeting modifiable factors, including adoption of appropriate oncologic techniques, standardized pathology reporting, and potential neoadjuvant strategies. K E Y W O R D Scircumferential resection margin, colon cancer, risk factors, survival

Surgical treatment of locally advanced right colon cancer invading neighboring organs

“…This problem had received the substantial interests of colorectal surgeons and they finally produced the significant operation procedure, the RHC with pancreatoduodenectomy which was defined as en bloc resection. This surgical method is considered to be quite difficult surgically in general, and there are relatively many complications including post-operative pancreas and/or gallbladder fistula, and post-operative patient management is relatively difficult and complex while the advantage of this en bloc resection is relatively radical and increases the survival rate of the patient after surgery (3,15,36).…”

Prognostic significance of additional histologic features for subclassification of pathological T3 colon cancer

“…NCDB registry showed that a positive CRM were common in pT4 (26–32% of patients), whereas in pT2 and pT3 colon cancer is less common (6 and 11% of patients respectively) [ 41 ]. A positive CRM should be an indication for adjuvant treatment in stage II colon cancer, however in only 9% of these patients were reported [ 42 ]. Nevertheless, the histopathological parameters that we considered are more common in T3 colon cancer patients, representing in both cases more than 40% of the patients.…”

Incidence, predictors and prognostic implications of positive circumferential resection margin in colon cancer: A retrospective study in a Chinese high-volume cancer center

“…retrospectively analyzed 984 patients with surgically treated CC and identified 52 (5.3%) patients with a positive CRM ( 8 ). Another study included 189,343 locally advanced CC patients from the National Cancer Database and demonstrated that positive CRM was identified in 9% of stage II and 12% of stage III CC patients ( 9 ). A SEER-based study reported that 20.5% patients were CRM-positive following resection of CC in general population, which represented the highest rate of positive CRM in CC ( 11 ) among the listed studies.…”

“…Several sporadic studies reported the incidence, risk factors and prognostic implications of positive CRM in colon cancer with great heterogeneity (7)(8)(9)(10)(11). These studies provided important insights into CRM of colon cancer in western countries.…”