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The Need for Consensus and Transparency in Assessing Population-Based Rates of Positive Circumferential Radial Margins in Rectal Cancer: Data from Consecutive Cases in a Large Region of Ontario, Canada

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A positive circumferential radial margin (CRM) after rectal cancer surgery is an important predictor of local recurrence. The definition of a positive CRM differs internationally, and reported rates vary greatly in the literature. This study used time-series population-based data to assess positive CRM rates in a region over time and to inform future methods of CRM analysis in a defined geographic area.

Methods

Chart reviews provided relevant data from consecutive patients undergoing rectal cancer surgery between 2006 and 2012 in all hospitals of the authors’ region. Outcomes included rates for pathologic examination of CRM, CRM distance reporting, and positive CRM. The rate of positive CRM was calculated using various definitions. The variations included positive margin cutoffs of CRM at 1 mm or less versus 2 mm or less and inclusion or exclusion of cases without CRM assessment.

Results

In this study, 1222 consecutive rectal cancer cases were analyzed. The rate for pathology reporting of CRM distance increased from 54.7 to 93.2 % during the study. Depending on how the rate of positive CRM was defined, its value varied 8.5 to 19.4 % in 2006 and 6.0 to 12.5 % in 2012. Using a pre-specified definition, the rate of positive CRM decreased over time from 14.0 to 6.3 %.

Conclusions

A marked increase in CRM distance reporting was observed, whereas the rates of positive CRM dropped, suggesting improved pathologist and surgeon performance over time. Changing definitions greatly influenced the rates of positive CRM, indicating the need for more transparency when such population-based rates are reported in the literature.

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Acknowledgment

This research received funding from the Juravinski Cancer Centre Foundation; McMaster Surgical Associates, Department of Surgery, McMaster University; Hamilton Academic Health Sciences Organization; and the Hamilton Health Sciences Centre for Healthcare Optimization Research and Delivery (CHORD). Our funders had no role in the planning, execution, interpretation, or writing of the study.

Conflict of interest

The authors declared that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Christine Keng MD, Angela Coates MEd, Vanja Grubac BSc, Peter Lovrics MD & Marko Simunovic MD

  2. Department of Pathology, St. Catharines General Site, Niagara Health System, St. Catharines, ON, Canada

    Franco DeNardi MD

  3. Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Lehana Thabane PhD & Marko Simunovic MD

  4. Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    Marko Simunovic MD

  5. Escarpment Cancer Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada

    Marko Simunovic MD

  6. Department of Surgical Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada

    Marko Simunovic MD

Authors
  1. Christine Keng MD
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  2. Angela Coates MEd
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  3. Vanja Grubac BSc
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  4. Peter Lovrics MD
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  5. Franco DeNardi MD
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  6. Lehana Thabane PhD
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  7. Marko Simunovic MD
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Corresponding author

Correspondence to Marko Simunovic MD.

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Keng, C., Coates, A., Grubac, V. et al. The Need for Consensus and Transparency in Assessing Population-Based Rates of Positive Circumferential Radial Margins in Rectal Cancer: Data from Consecutive Cases in a Large Region of Ontario, Canada. Ann Surg Oncol 23, 397–402 (2016). https://doi.org/10.1245/s10434-015-4893-5

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  • DOI: https://doi.org/10.1245/s10434-015-4893-5

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