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Outcomes of rectal cancer patients with a positive pathological circumferential resection margin

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Abstract

Purpose

Evidence-based management of positive pathological circumferential resection margin (pCRM) following preoperative radiation and an adequate rectal resection for rectal cancers is lacking.

Methods

Retrospective analysis of prospectively maintained single-centre institutional database was done to study the patterns of failure and management strategies after a rectal cancer surgery with a positive pCRM.

Results

A total of 86 patients with rectal adenocarcinoma with a positive pCRM were identified over 8 years (2011–2018). Majority had low-lying rectal cancers (90.7%) and were operated after preoperative radiotherapy (95.3%). Operative procedures included abdomino-perineal resections, inter-sphincteric resections, low anterior resections and pelvic exenteration in 61 (70.9%), 9 (10.5%), 11(12.8%) and 5 (5.8%) patients respectively. A total of 83 (96.5%) received chemotherapy as the sole adjuvant treatment modality while 2 patients (2.3%) were given post-operative radiotherapy and 1 patient underwent revision surgery. A total of 53 patients (61.6%) had recurrence, with 16 (18.6%), 20 (23.2%), 8(9.3%) and 9 (10.5%) patients having locoregional, systemic, peritoneal and simultaneous local-systemic relapse. Systemic recurrences were more often detected either by surveillance in an asymptomatic patient (20.1%) while local (13.1%) and peritoneal (13.2%) recurrences were more often symptomatic (p = 0.000). The 2-year overall survival (OS) and disease-free survival (DFS) of the cohort was 82.4% and 74.0%. Median local recurrence-free survival (LRFS) was 10.3 months.

Conclusions

Patients with a positive pCRM have high local and distal relapse rates. Systemic relapses are more often asymptomatic as compared to peritoneal or locoregional relapse and detected on follow-up surveillance. Hence, identification of such recurrences while still salvageable via an intensive surveillance protocol is desirable.

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Data availability

The data used in the manuscript will be available upon request from the corresponding author.

Code availability

Not applicable.

Abbreviations

APR:

Abdomino-perineal resection

LAR:

Low anterior resection

ISR:

Inter-sphincteric resection

pCRM:

Pathological circumferential resection margin

TME:

Total mesorectal excision

b-TME:

Beyond TME

e-TME:

Extended TME

MRF:

Mesorectal fascia

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Authors and Affiliations

  1. Colorectal Division, Department of GI & HPB Surgery, Tata Memorial Centre, Homi Bhabha National University Mumbai, Mumbai, India, 400012

    Swapnil Patel, Mufaddal Kazi, Ashwin L. Desouza, Vivek Sukumar, Jayesh Gori & Avanish Saklani

  2. Department of Pathology, Tata Memorial Centre, Homi Bhabha National University Mumbai, Mumbai, India, 400012

    Munita Bal

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  1. Swapnil Patel
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  2. Mufaddal Kazi
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  3. Ashwin L. Desouza
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  4. Vivek Sukumar
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  5. Jayesh Gori
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  6. Munita Bal
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  7. Avanish Saklani
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Correspondence to Avanish Saklani.

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Patel, S., Kazi, M., Desouza, A.L. et al. Outcomes of rectal cancer patients with a positive pathological circumferential resection margin. Langenbecks Arch Surg 407, 1151–1159 (2022). https://doi.org/10.1007/s00423-021-02392-6

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  • DOI: https://doi.org/10.1007/s00423-021-02392-6

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