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

  • G. S. SimpsonEmail author
  • N. Eardley
  • F. McNicol
  • P. Healey
  • M. Hughes
  • P. S. Rooney
Original Article

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.

Keywords

Rectal cancer MRI Circumferential resection margin 

Notes

Acknowledgments

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

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • G. S. Simpson
    • 1
    Email author
  • N. Eardley
    • 2
  • F. McNicol
    • 1
  • P. Healey
    • 3
  • M. Hughes
    • 3
  • P. S. Rooney
    • 1
  1. 1.Department of General SurgeryRoyal Liverpool University HospitalLiverpoolUK
  2. 2.Department of General SurgeryCountess of Chester HospitalChesterUK
  3. 3.Department of RadiologyRoyal Liverpool University HospitalLiverpoolUK

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