Pathologists’ Role in the Evaluation of the Prognostic Implications of Circumferential Resection Margin in Resected Rectal Carcinoma
American Journal of Laboratory Medicine
Volume 4, Issue 2, March 2019, Pages: 40-43
Received: Mar. 12, 2019; Accepted: Apr. 13, 2019; Published: May 15, 2019
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Bimalka Seneviratne, Department of Pathology, Cancer Research Centre, Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
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Colorectal cancer is one of the most common malignancies in Sri Lanka as well as in other parts of the world and has a high incidence of cancer related deaths. Recent advances have been made with regard to the biological understanding of this disease and its treatment. Furthermore, new surgical, chemotherapeutic and radiotherapeutic strategies have been developed over the last decade in view of improving the quality of care. The worldwide introduction of total mesorectal excision (TME) in combination with the increasing use of neoadjuvant therapy has significantly improved the overall outcome. An important prognostic factor in rectal cancer is the status of the circumferential resection margin (CRM). The involvement of this margin has been associated with a poor prognosis. Pathologists play a vital role by providing important information for the clinical management of the patient and for the evaluation of health care as a whole. For the patient it confirms the diagnosis and describes the variables that will affect the prognosis, all of which will be relevant for the future management. For health care evaluation, pathology reports provide information for cancer registration and audit related to diagnostic and surgical procedures. Accurate evaluation of CRM in rectal carcinoma is important to determine the risk of local recurrence, which might subsequently be prevented by additional therapy. An increased risk was seen when the distance to CRM was < 2 mm.
Colorectal Cancer, Total Mesorectal Excision, Circumferential Resection Margin
To cite this article
Bimalka Seneviratne, Pathologists’ Role in the Evaluation of the Prognostic Implications of Circumferential Resection Margin in Resected Rectal Carcinoma, American Journal of Laboratory Medicine. Vol. 4, No. 2, 2019, pp. 40-43. doi: 10.11648/j.ajlm.20190402.13
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Andrew R Marley, Hongmei Nan. Epidemiology of colorectal cancer. Int J Mol Epidemiol Genet. 2016; 7 (3): 105-114.
Bishehsari F, Mahdavinia M, Vacca M, Malekzadeh R, Mariani-Costantini R. Epidemiological transition of colorectal cancer in developing countries: environmental factors, molecular pathways, and opportunities for prevention. World J Gastroenterol. 2014; 20:6055–72.
Cancer Incidence Data, National Cancer Control Program, Sri Lanka 2014.
Heald RJ, Husband EM, Ryall RDH. "The mesorectum in rectal cancer surgery—the clue to pelvic recurrence?". British Journal of Surgery.1982; 69 (10): 613–6. doi: 10.1002/bjs.1800691019. PMID 6751457.
Heald RJ. The ‘Holy Plane’ of rectal surgery. J R Soc Med. 1988; 81: 503–80.
Samir Delibegovic. Introduction to Total Mesorectal Excision. Med Arch. 2017; 71 (6): 434-438. doi: 10.5455/medarh.2017.71.434-438.
Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet. 1994; 344: 707–711. 7.
Decaria K, Rahal R, Niu J, Lockwood G, Bryant H and in collaboration with the System Performance Steering Committee & the Technical Working Group. Rectal cancer resection & circumferential margin rates in Canada; a population based study. Curr Oncol. 2015; 22 (1): 60-63.
Compton CC. Updated protocol for the examination of specimens from patients with carcinomas of the colon and rectum, excluding carcinoid tumors, lymphomas, sarcomas, and tumors of the vermiform appendix: a basis for checklists. Cancer Committee. Arch Pathol Lab Med.2000; 124: 1016–1025.
Hermanek P, Hohenberger W, Klimpfinger M, et al. The pathological assessment of mesorectum excision: implications for further treatment and quality management. Int J colorectal Dis. 2003; 18: 335–41.
Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. College of American Pathologists, 2013 (accessed 15 July 2014).
Nagtegaal, Iris D, Marijnen, Corrie A M, Kranenbarg, Elma Klein MSC, van de Velde, Cornelis JH, van Krieken J, Han J M. Pathology Review Committee the Cooperative Clinical Investigators. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. American journal of surgical pathology. 2002; 26:350-357.
Healed RJ, Ryall RDH. Recurrence & survival after total mesorectal excision for rectal cancer. The Lancet. 1986; 8496: 1479- 1482.
Garcia–Granero E, Faiz O, Munoz E, Flor B, Navarro S, Faus C et al. Macroscopic assessment of mesorectal excision in rectal cancer: a useful tool for improving quality control in a multidisciplinary team. Cancer. 2009; 115: 3400–3411.
Branston LK, Greening S, Newcombe RG, Daoud R, Abraham JM, Wood F et al. The implementation of guidelines and computerised forms improves the completeness of cancer pathology reporting. The CROPS project: a randomised controlled trial in pathology. Eur J Cancer. 2002; 38: 764–772.
Bull AD, Biffin AH, Mella J, Radcliffe AG, Stamatakis JD, Steele RJ, Williams GT. Colorectal cancer pathology reporting: a regional audit. Journal of clinical pathology. 1997; 50: 138-142.
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