The significance of extramural venous invasion in R1 positive rectal cancer

Abstract

In this small cohort of patients with R1 positive rectal cancers, response to NAC is the strongest predictor of poor overall and disease-free survival. In patients who respond to NAC, OS and DFS has been shown to be positive, with a reduced rate of EMV.

Clinicopathological factors associated with positive circumferential margins in rectal cancers

“…Our series also demonstrates the aggressive pathological phenotypes of rectal cancers with positive CRM encountered in our population. Factors associated with positive CRM including APR as mode of surgery, worsening tumour grade, increased T‐stage, vascular and perineural invasion have previously been established . Patients undergoing APR are more likely to have locally advanced and distal tumours increasing the complexity of resection .…”

“…Factors associated with positive CRM including APR as mode of surgery, worsening tumour grade, increased T-stage, vascular and perineural invasion have previously been established. 4,5,7,8 Patients undergoing APR are more likely to have locally advanced and distal tumours increasing the complexity of resection. 12 Although extra-levator APR in the prone jack-knife position has been demonstrated to have improved oncological outcomes and a lower CRM positivity rate, 13 uptake of this technique has been limited to two or three surgeons in our region, and we were unable to determine APR technique in our data-set.…”

“…Examples in recent studies range from 7.8% to 21% in centres located in Australia, New Zealand, USA, UK and Canada . Several factors have been associated with CRM status including technical performance, social demographics, hospital case load, neoadjuvant therapies, procedure performed (low anterior resection versus abdominoperineal resection (APR)) and tumour biology . Staged as R1c, involved CRMs are not only reflective of technical success but also of aggressive disease phenotypes.…”

“…[3][4][5][6][7] Several factors have been associated with CRM status including technical performance, social demographics, hospital case load, neoadjuvant therapies, procedure performed (low anterior resection versus abdominoperineal resection (APR)) and tumour biology. 4,8 Staged as R1c, involved CRMs are not only reflective of technical success but also of aggressive disease phenotypes. Unfavourable pathological tumour characteristics have been shown to contribute including tumour budding as well as perineural and lymphovascular invasion which may indicate need for adjuvant treatment in cancers with otherwise favourable T-staging.…”

The Impact of Extramural Venous Invasion in Colorectal Cancer: A Detailed Analysis Based on Tumor Location and Evaluation Methods

“…The following data were collected from the full texts of eligible studies: the first author's name, study location, information of tumor, year of publication, number of patients analyzed, evaluation method of venous invasion, the rates of EMVI, and the data for survival rate. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] We did not define a minimal number of patients to be included in a study. The estimated hazard ratio (HR) and its standard error using given parameters, which were the HR point estimate, log-rank statistic or its P value, O-E statistic (difference between numbers of observed and expected events), or its variance, were aggregated.…”