Abstract
Background
The objective of this study was to assess the value of preoperative pelvimetry, using magnetic resonance imaging (MRI), in predicting the risk of an involved circumferential resection margin (CRM) in a group of patients with operable rectal cancer.
Methods
A cohort of 186 patients from the MERCURY study was selected. These patients’ histological CRM status was compared against 14 pelvimetry parameters measured from the preoperative MRI. These measurements were taken by one of the investigators (G.S.), who was blinded to the final CRM status.
Results
There was no correlation between the pelvimetry and the CRM status. However, there was a difference in the height of the rectal cancer and the positive CRM rate (p = 0.011). Of 61 patients with low rectal cancer, 10 had positive CRM at histology (16.4% with CI 8.2%–22.1%) compared with 5 of 110 patients with mid/upper rectal cancers (4.5% with CI 0.7%–8.4%).
Conclusions
Magnetic resonance imaging can predict clear margins in most cases of rectal cancer. Circumferential resection margin positivity cannot be predicted from pelvimetry in patients with rectal cancer selected for curative surgery. The only predictive factor for a positive CRM in the patients studied was tumor height.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Stark DD, McCarthy SM, Filly RA, et al. (1985) Pelvimetry by magnetic resonance imaging. AJR Am J Roentgenol 144:947–950
Trousdale RT, Cabanela ME, Berry DJ, et al. (2002) Magnetic resonance imaging pelvimetry before and after a periacetabular osteotomy. J Bone Joint Surg Am 84-A:552–556
Buhre LM, Mulder NH, de Ruiter AJ, et al. (1994) Effect of extent of anterior resection and sex on disease-free survival and local recurrence in patients with rectal cancer. Br J Surg 81:1227–1229
Tague RG (1989) Variation in pelvic size between males and females. Am J Phys Anthropol 80:59–71
Quirke P, Durdey P, Dixon MF, et al. (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2:996–999
Brown G, Richards CJ, Newcombe RG, et al. (1999) Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology 211:215–222
Brown G, Radcliffe AG, Newcombe RG, et al. (2003) Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg 90:355–364
Guillou PJ, Quirke P, Thorpe H, et al. (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726
Brown G, Daniels IR (2005) Preoperative staging of rectal cancer: the MERCURY research project. Recent Results Cancer Res 165:58–74
Eriksen MT, Wibe A, Syse A, et al. (2004) Inadvertent perforation during rectal cancer resection in Norway. Br J Surg 91:210–216
Nagtegaal ID, Kranenbarg EK, Hermans J, et al. (2000) Pathology data in the central databases of multicenter randomized trials need to be based on pathology reports and controlled by trained quality managers. J Clin Oncol 18:1771–1779
Croxford MSG, Watson M, Heald R, et al. (2004) Colorectal 23–28. Br J Surg 91:63–65
McDermott FT, Hughes ES, Pihl E, et al. (1985) Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients. Br J Surg 72:34–37
Boyle KM, Petty D, Chalmers AG, et al. (2005) MRI assessment of the bony pelvis may help predict resectability of rectal cancer. Colorectal Dis 7:232–240
Boyle KM FP, Sagar PM, Burke D (2004) The relationship between mesorectal morphology and gender in patients with primary rectal cancer. Eur J Cancer Surg 30:1020
Boyle KMPD, Chalmers AG, Quirke P, et al. (2004) The relationship between pelvic morphology and involvement of the circumferential resection margin in surgery for rectal cancer. Colorectal Dis 6:12
Wibe A, Rendedal PR, Svensson E, et al. (2002) Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 89:327–334
Martling AL, Holm T, Rutqvist LE, et al. (2000) Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet 356:93–96
Nagtegaal ID, Marijnen CA, Kranenbarg EK, et al. (2002) Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 26:350–357
Nagtegaal ID, van de Velde CJ, Marijnen CA, et al. (2005) Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol 23:9257–9264
Brown G (2004) Local radiological staging of rectal cancer. Clin Radiol 59:213–214
Acknowledgments
The authors are grateful for the assistance in the interpretation of the MRI scans from Dr. Gina Brown; to measurements Mr. Ian Daniels and Mr. Brendan Moran for devising of the pelvimetry. They also acknowledge the statistical evaluation of this study by Dr. Andy Norman and the financial support of the Pelican Cancer Foundation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Salerno, G., Daniels, I.R., Brown, G. et al. Variations in Pelvic Dimensions Do Not Predict the Risk of Circumferential Resection Margin (CRM) Involvement in Rectal Cancer. World J Surg 31, 1315–1322 (2007). https://doi.org/10.1007/s00268-007-9007-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-007-9007-5