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Feasibility of the semi-opened method of specimen resection for a circumferential resection margin in rectal cancer surgery: a multicenter study

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Abstract

Purpose

A circumferential resection margin (CRM) > 1 mm is a surrogate marker of oncologic outcomes in rectal cancer patients. In Japan, because the mesentery is removed from the rectum, the CRM cannot be measured. This multicenter prospective study evaluates the feasibility of a resected specimen processing method that allows CRM measurement.

Methods

Fifty patients with rectal cancer were enrolled. Resected specimens were processed as previously reported. The primary outcomes were CRM measurement and the rate of CRM positivity. The secondary outcomes were the quality of total mesorectal excision, the possibility to visualize and sample the tumor, the number of harvested lymph nodes, and comparison between the pathological CRM and preoperative mesorectal fascia (MRF) involvement. This study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry under identification number UMIN000031735.

Results

The CRM was measurable in all patients and found to be positive in three (6%). We confirmed tumor localization, sampled the tumor, and measured the distal margin in all patients. A median of 20 lymph nodes were harvested. The concordance rate between preoperative MRF involvement and pathological CRM status was 90%.

Conclusion

A semi-opened rectal specimen with transverse slicing is a feasible method for measuring the CRM.

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Data availability

The data produced and analyzed for this study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Drs M Kojima, T Yoshida, T Sakurai, H Kawachi, T Daa, and U Itai for their contribution as advisors on pathology, and Y Tsukada, T Nakamura, K Hida, and H Shiroshita for their contribution to the data collection.

Funding

No funding was received for the conduct of this research and or its publication.

Author information

Author notes

  1. Ichiro Takemasa and Koichi Okuya the first co-authors contributed equally to this study.

Authors and Affiliations

  1. The Japan Society for Endoscopic Surgery, Tokyo, Japan

    Ichiro Takemasa, Koichi Okuya, Kenji Okita, Masayuki Ishii, Masaaki Ito, Kay Uehara, Tsuyoshi Konishi, Shigeki Yamaguchi, Masafumi Inomata, Yoshiharu Sakai & Masahiko Watanabe

  2. Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S1 W16, Chuo-ku, Sapporo, 060-8543, Japan

    Ichiro Takemasa, Koichi Okuya, Kenji Okita & Masayuki Ishii

  3. Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan

    Masaaki Ito

  4. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Kay Uehara

  5. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Tsuyoshi Konishi

  6. Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan

    Shigeki Yamaguchi

  7. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan

    Masafumi Inomata

  8. Department of Surgical Pathology, Sapporo Medical University, Sapporo, Japan

    Shintaro Sugita & Tadashi Hasegawa

  9. Division of Biomarker Discovery, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan

    Atsushi Ochiai

  10. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Yoshiharu Sakai

  11. Department of Surgery, Kitasato Institute Hospital, Tokyo, Japan

    Masahiko Watanabe

Authors
  1. Ichiro Takemasa
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  2. Koichi Okuya
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  3. Kenji Okita
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  4. Masayuki Ishii
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  5. Masaaki Ito
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  6. Kay Uehara
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  7. Tsuyoshi Konishi
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  8. Shigeki Yamaguchi
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  9. Masafumi Inomata
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  10. Shintaro Sugita
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  11. Tadashi Hasegawa
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  12. Atsushi Ochiai
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  13. Yoshiharu Sakai
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  14. Masahiko Watanabe
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Corresponding author

Correspondence to Ichiro Takemasa.

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Conflict of interest

Drs. K Okuya, I Takemasa, K Okita, M Ishii, M Ito, K Uehara, S Yamaguchi, M Inomata, S Sugita, T Hasegawa, A Ochiai, Y Sakai, and M Watanabe have no conflicts of interest to declare. Dr T Konishi received honoraria from Johnson and Johnson Japan and Medtronic Japan.

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Takemasa, I., Okuya, K., Okita, K. et al. Feasibility of the semi-opened method of specimen resection for a circumferential resection margin in rectal cancer surgery: a multicenter study. Surg Today 52, 1275–1283 (2022). https://doi.org/10.1007/s00595-022-02481-z

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  • DOI: https://doi.org/10.1007/s00595-022-02481-z

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