Skip to main content
SpringerLink
Log in

Circumferential resection margin (CRM) positivity after MRI assessment and adjuvant treatment in 189 patients undergoing rectal cancer resection

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The management of rectal cancer relies on accurate MRI staging. Multi-modal treatments can downstage rectal cancer prior to surgery and may have an effect on MRI accuracy. We aim to correlate the findings of MRI staging of rectal cancer with histological analysis, the effect of neoadjuvant therapy on this and the implications of circumferential resection margin (CRM) positivity following neoadjuvant therapy.

Methods

An analysis of histological data and radiological staging of all cases of rectal cancer in a single centre between 2006 and 2011 were conducted.

Results

Two hundred forty-one patients had histologically proved rectal cancer during the study period. One hundred eighty-two patients underwent resection. Median age was 66.6 years, and male to female ratio was 13:5. R1 resection rate was 11.1 %. MRI assessments of the circumferential resection margin in patients without neoadjuvant radiotherapy were 93.6 and 88.1 % in patients who underwent neoadjuvant radiotherapy. Eighteen patients had predicted positive margins following chemoradiotherapy, of which 38.9 % had an involved CRM on histological analysis.

Conclusions

MRI assessment of the circumferential resection margin in rectal cancer is associated with high accuracy. Neoadjuvant chemoradiotherapy has a detrimental effect on this accuracy, although accuracy remains high. In the presence of persistently predicted positive margins, complete resection remains achievable but may necessitate a more radical approach to resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341(8843):457–460

    Article  CAS  PubMed  Google Scholar 

  2. Birbeck KF, Macklin CP, Tiffin NJ et al (2002) Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 235(4):449–457

    Article  PubMed Central  PubMed  Google Scholar 

  3. Trakarnsanga A, Gonen M, Shia J et al (2013) What is the significance of the circumferential margin in locally advanced rectal cancer after neoadjuvant chemoradiotherapy? Ann Surg Oncol 20(4):1179–1184

    Article  PubMed  Google Scholar 

  4. Kapiteijn E, Marijnen CA, Naqteqaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345(9):638–646

    Article  CAS  PubMed  Google Scholar 

  5. Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRCCR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373(9666):811–820

    Article  PubMed Central  PubMed  Google Scholar 

  6. Sauer R, Liersch T, Merkel S et al (2012) Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 30(16):1926–1933

    Article  CAS  PubMed  Google Scholar 

  7. Gerard JP, Conroy T, Bonnetain F et al (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 24(28):4620–4625

    Article  PubMed  Google Scholar 

  8. Peeters KC, Marijnen CA, Nagteqaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246(5):693–701

    Article  PubMed  Google Scholar 

  9. MIgnanelli ED, de Campos-Lobato LF, Stocchi L, Lavery IC, Dietz DW (2010) Downstaging after chemoradiotherapy for locally advanced rectal cancer: is there more (tumor) than meets the eye. Dis Colon Rectum 53(3):251–256

    Article  PubMed  Google Scholar 

  10. Beddy D, Hyland JM, Winter DC et al (2008) A simplified tumor regression grade correlates with survival in locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy. Ann Surg Oncol 15(12):3471–3477

    Article  CAS  PubMed  Google Scholar 

  11. Videhult P, Smedh K, Lundin P, Kraaz W (2007) Magnetic resonance imaging for preoperative staging of rectal cancer in clinical practice: high accuracy in predicting circumferential margin with clinical benefit. Color Dis 9(5):412–419

    Article  CAS  Google Scholar 

  12. Al-Sukhni E, Milot L, Fruitman M et al (2012) Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol 19(7):2212–2223

    Article  PubMed  Google Scholar 

  13. MERCURY Study Group (2007) Extramural depth of tumour invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology 243(1):132–139

    Article  Google Scholar 

  14. Brown G, Davies S, Williams GT et al (2004) Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging? Br J Cancer 91(1):23–29

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Branagan C, Chave H, Fuller C, McGee S, Finnis D (2004) Can magnetic resonance imaging predict circumferential margins and TNM stage in rectal cancer? Dis Colon Rectum 47(8):1317–1322

    Article  PubMed  Google Scholar 

  16. Purkavastha S, Tekkis PP, Athanasiou T, Tilney HS, Darzi AW, Heriot AG (2007) Diagnostic precision of magnetic resonance imaging for preoperative prediction of the circumferential margin involvement in patients with rectal cancer. Color Dis 9(5):402–411

    Article  Google Scholar 

  17. MERCURY study group (2006) Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 333(7572):779

    Article  PubMed Central  Google Scholar 

  18. Beets-Tan RG, Beets GL, Vliegen RF et al (2001) Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet 357(9255):497–504

    Article  CAS  PubMed  Google Scholar 

  19. Oberholzer K, Junginger T, Heintz A et al (2012) Rectal cancer: MR imaging of the mesorectal fascia and effect of chemoradiation on assessment of tumor involvement. J Magn Reson Imaging 36(3):658–663

    Article  PubMed  Google Scholar 

  20. Villegen RF, Beets GL, Lammering G et al (2008) Mesorectal fascia invasion after neoadjuvant chemotherapy and radiation therapy for locally advanced rectal cancer: accuracy of MR imaging for prediction. Radiology 246(2):454–462

    Article  Google Scholar 

  21. Quirke P, Steele R, Monson J et al (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373(9666):821–828

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Dr. Fiona Campbell, Mr. Ufuk Gur, Mr. Paul S. Carter and Mr. Richard Heath for their help in this study.

Author information

Authors and Affiliations

  1. Department of General Surgery, Royal Liverpool University Hospital, Liverpool, England, UK

    G. S. Simpson, F. McNicol & P. S. Rooney

  2. Department of General Surgery, Countess of Chester Hospital, Chester, England, UK

    N. Eardley

  3. Department of Radiology, Royal Liverpool University Hospital, Liverpool, England, UK

    P. Healey & M. Hughes

Authors
  1. G. S. Simpson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Eardley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. McNicol
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Healey
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Hughes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. S. Rooney
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. S. Simpson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Simpson, G.S., Eardley, N., McNicol, F. et al. Circumferential resection margin (CRM) positivity after MRI assessment and adjuvant treatment in 189 patients undergoing rectal cancer resection. Int J Colorectal Dis 29, 585–590 (2014). https://doi.org/10.1007/s00384-014-1846-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-014-1846-6

Keywords

Search

Navigation