Circumferential resection margin in the modern treatment of rectal cancer
Authors:
P. Ihnát; L. Martínek 1,2
; L. Ihnát Rudinská 1,2; M. Mitták 3; P. Vávra 1,2; P. Zonča 1,2 1,2
Authors place of work:
Katedra chirurgických oborů, Lékařská fakulta Ostravské Univerzity
vedoucí katedry: Doc. MUDr. P. Zonča, Ph. D., FRCS
1; Chirurgická klinika, FN Ostrava, přednosta: Doc. MUDr. P. Zonča, Ph. D., FRCS
2; Ústav soudního lékařství, FN Ostrava, přednosta: MUDr. I. Dvořáček, Ph. D.
3
Published in the journal:
Rozhl. Chir., 2013, roč. 92, č. 6, s. 297-303.
Category:
Review
Summary
Introduction:
In the last decades, the assessment of circumferential resection margin (CRM) has gained enormous importance in the management of patients with rectal carcinoma, not only in predicting the prognosis, but also in precise cancer staging, in multimodal treatment indications and in quality assessment of provided care.
Methods:
The authors present a review article containing CRM definition, describing the technique of CRM assessment, the effect of CRM status on the prognosis and quality of provided therapy. CRM assessment in the context of a multidisciplinary team is especially emphasised. The aspect of CRM has to be considered by the radiologist during cancer staging, the surgeon in the course of the operation, the pathologist during precise macroscopic and histopathological specimen evaluation, and the oncologist when deciding on neoadjuvant/adjuvant therapy administration.
Conclusion:
CRM nowadays represents a fundamental aspect in modern treatment of patients with rectal carcinoma. The introduction of CRM assessment into clinical practice has lead to more precise staging, better multimodal therapy indications, more precise surgical technique (total mesorectal excision), an increased rate of sphincter-saving resections, lowered local recurrence rates and improved patient survival.
Key words:
rectal carcinoma – circumferential resection margin – total mesorectal excision – multidisciplinary approach
Zdroje
1. How P, Shihab O, Tekkis P, Brown G, Quirke P, Heald R, Moran B. A systematic review of cancer related patient outcomes after anterior resection and abdominoperineal excision for rectal cancer in the total mesorectal excision era. Surg Oncol 2011; 20:149–155.
2. Becker HD, Jehle E, Kratt T, Mehl C, Volke K. Karcinom rekta. In: Becker HD et al. Chirurgická onkologie. Praha, Grada 2005:515–539.
3. Hoch J. Chirurgická léčba kolorektálního karcinomu. Rozhl Chir 2012;91,1:48–52.
4. Quirke P. Training and quality assurance for rectal cancer: 20 years of data is enough. The Lancet Oncology 2003;4:695–701.
5. Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 2008;26,2:303–312.
6. Titu LV, Tweedle E, Rooney PS. High tie of the inferior mesenteric artery in curative surgery for left colonic and rectal cancer: a systematic review. Dig Surg 2008;28:148–157.
7. Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer. The Basingstoke experience of total meesorectal excision, 1987–1997. Arch Surg 1998;133:894–899.
8. Kirwan WA, Drumm J, Hogan JM, Keohane C. Determining safe margin of resection in low anterior resection for rectal cancer. Br J Surg 1988;75:720–721.
9. Moore HG, Riedel E, Minsky BD, Saltz L, Paty P, Wong D, Cohen AM, Guillem JG. Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapy. Ann Surg Oncol 2003;10,1:80–85.
10. Ueno H, Mochizuki H, Hashiguchi Y. Preoperative parameters expanding the indication of sphincter preserving surgery in patients with advanced low rectal cancer. Ann Surg 2004;239:34–42.
11. Lipská L. Lokální recidiva karcinomu rekta. In: Lipská L, Visokai V, et al. Recidiva kolorektálního karcinomu. Komplexní přístup z pohledu chirurga. Praha, Grada, 2009:307–321.
12. Washington MK, Berlin J, Branton P, Burgart LJ, Carter DK, Fitzgibbons PL, Haling K, Frankel W, Jessup J, Kakar S, Minsky B, Nakhleh R, Compton CC. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med 2009;133:1539–1551.
13. Hermanek P, Junginger T. The circumferential resection margin in rectal carcinoma surgery. Tech Coloproctol 2005;9:193–200.
14. Nagtegaal ID, Marijnen AM, Kranenbarg EK, van der Velde CJH, van Krieken JM. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma. Am J Surg Pathol 2002;26,3:350–357.
15. Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical incision. Lancet 1986;2:996–999.
16. Birbeck KF, Macklin CP, Tiffin NJ, Parsons W, Dixon MF, Mapstone NP, Abbott CR, Scott N, Finan PJ, Johnston DJ, Quirke P. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 2002;235,4:449–457.
17. Chan KW, Boey J, Wong SK. A method of reporting radial invasion and surgical clearance of rectal carcinoma. Histopathology 1985;9:1319–1327.
18. Rojo A, Sancho P, Alonsa O, Encinas S, Toledo G, Garcia JF. Update on the surgical pathology standards on rectal cancer diagnosis, staging and quality assessment of surgery. Clin Trans Oncol 2010;12:431–436.
19. Pricolo VE. Rectal Cancer: The good, the bad, and the ugly. Arch Surg 2011;146,5:544.
20. Ludwig K, Kosinski L. How low is low– Evolving approaches to sphincter-sparing resection techniques. Semin Radiat Oncol 2011;21:185–195.
21. Blomquist L, Glimelius B. The ‘good’, the ‘bad’, and the ‘ugly’ rectal cancers. Acta oncologica 2008;47:5–8.
22. Smith N, Brown G. Preoperative staging of rectal cancer. Acta oncologica 2008;47:20–31.
23. Monson JRT. Laparoscopic resection for rectal cancer and circumferential margin: is it time to move on? Dis Colon Rectum 2011;54,8:1049–1052.
24. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery. The clue to pelvic recurrence? Br J Surg 1982; 69:613–616.
25. Wibe A, Rendedal PR, Svensson E, Norstein J, Eide TJ, Myrvold HE, Soreide O. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 2002;89:327–334.
26. Herzog T, Belyaev O, Chromik AM, Weyhe D, Mueller CA, Munding J, Tannapfel A, Uhl W, Seelig MH. TME quality in rectal cancer surgery. Eur J Med Res 2010;15,7:292–296.
27. MERCURY Study Group. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: Results of the MERCURY study. Radiology 2007;243:132–139.
28. Nagtegaal ID, Gosens MJ, Marijnen CA, et al. Combinations of tumor and treatment parameters are more discriminative for prognosis than the present TNM system in rectal cancer. J Clin Oncol 2007;25:1647–1650.
29. Gosens MJ, Van Krieken JH, Marijnen CA, et al. Improvement of staging by combining tumor and treatment parameters: The value of for prognostication in rectal cancer. Clin Gastroenterol Hepatol 2007;5:997–1003.
30. Martling AL, Holm T, Rutqvist LE, et al. Effect of a surgical training programe on outcome of rectal cancer in the County of Stockholm. Lancet 2000;356:93–96.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2013 Číslo 6
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole vs. Tramadol in Postoperative Analgesia
- Spasmolytic Effect of Metamizole
Najčítanejšie v tomto čísle
- Reexpansion pulmonary oedema after drainage of a long-term spontaneous pneumothorax – a case report
- Circumferential resection margin in the modern treatment of rectal cancer
- Incarcerated De Garengeot’s hernia complicated by gangrenous appendicitis
- Anatomic-surgical study of intercostobrachial nerve (ICBN) course in axilla during I. and II. level of axilla clearance in breast cancer and malignant melanoma