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Distal resection margins in rectal cancer specimens: differences in assessment between surgeons and pathologists and the influence of neoadjuvant chemoradiation

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Abstract

To investigate the discrepancy between the distal resection margin (DRM) assessed by surgeons and pathologists, and the impact of neoadjuvant chemoradiotherapy (nCRT) on DRM. This study included 67 rectal cancer patients undergoing elective surgery. DRMs were assessed through four different techniques: in vivo subjective estimative, made by the surgeon before the rectal resection (by palpation and visual estimative); in vivo objective, measured with a ruler before the rectal transection; ex vivo objective, measured right after resection of the specimen; post-fixation objective measurement, conducted by the pathologist. The DRMs subjectively and objectively assessed by the surgeons were not significantly different (3.40 cm vs. 3.45 cm). There was a mean reduction in the length of DRMs of 35.6%, from 3.45 cm objectively measured by the surgeon to 2.20 cm measured by the pathologist. This difference was significant among patients that did not receive nCRT (3.90 cm vs. 2.30 cm, P < 0.001), but not among those who received nCRT (2.30 vs. 2.05 cm). Surgeons are accurate in assessing rectal cancer DRMs. There are significant differences between intraoperative measurements of DRMs and the final pathologic results. However, these differences are not seen when nCRT is used, a finding that may be useful when sphincter preservation is being considered.

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Authors and Affiliations

  1. Division of Coloproctology, Hospital de Clínica de Porto Alegre, Rua Ramiro Barcelos 2350, sala (room) 600, Porto Alegre, Rio Grande Do Sul, 90 035-903, Brazil

    T. L. Ghezzi, C. Tarta, P. C. Contu, A. R. Lazzaron & D. C. Damin

  2. Department of Pathology, School of Medicine, Federal University of Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil

    L. M. Kliemann

  3. Postgratuate Program in Surgical Sciences, School of Medicine, Federal University of Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil

    A. R. Lazzaron, B. M. Contin & D. C. Damin

Authors
  1. T. L. Ghezzi
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  2. C. Tarta
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  3. P. C. Contu
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  4. A. R. Lazzaron
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  5. B. M. Contin
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  6. L. M. Kliemann
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  7. D. C. Damin
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Contributions

TLG design the study, data acquisition, writing the manuscript. CT data acquisition, revision of the paper. PCC data acquisition, revision of the paper. ARL design the study, data acquisition, revision of the paper. BMC data acquisition. LMK data acquisition. DCD design the study, data acquisition, writing the manuscript.

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Correspondence to D. C. Damin.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the institutional review board on June 10, 2013 (CAAE: 13562713.5.0000.5327) and registered in the Brazilian National Research Repository (Plataforma Brasil).

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Informed consent was obtained from all individual participants included in the study.

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Ghezzi, T.L., Tarta, C., Contu, P.C. et al. Distal resection margins in rectal cancer specimens: differences in assessment between surgeons and pathologists and the influence of neoadjuvant chemoradiation. Updates Surg 73, 1787–1793 (2021). https://doi.org/10.1007/s13304-021-01102-7

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  • DOI: https://doi.org/10.1007/s13304-021-01102-7

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