Factor Determining Circumferential Resection Margin of Rectal Cancer: Operation in Pranangklao Hospital
Keywords:
Circumferential resection margin, Rectal cancer, Total mesorectal excisionAbstract
Background: The incidence of colorectal cancer in Thailand ranks as the first most common cancer in males and the second most common cancer in females. The incidence increases in individuals over 50 years of age. Regional lymph node metastasis is observed in 27% of cases. Treatment outcomes for rectal cancer are generally less favorable than those for colon cancer. Total mesorectal excision (TME) remains the standard treatment. Objective: This study aimed to analyze the factors associated with positive circumferential resection margin (CRM) (≤ 1 mm) in patients with rectal cancer after surgery. Methods: This study retrospectively analyzed data from medical records of patients with rectal cancer (ICD 10th: C19, C20) who underwent definitive surgery (ICD 9th: 48.50, 48.51, 48.51, 48.62, 48.63) between 2019 and 2024 (5 years) at Pranangklao Hospital (n = 85). Univariate, univariable, and multivariable statistical analyses were performed to assess risk factors. Results: The main statistically significant risk factors (p < .05) identified were anterior tumor location, T4 lesion, and stage III disease (lymph node metastasis). The overall positive CRM rate was 31.8% of all patients. Conclusion: This study demonstrated that anterior tumor location, T4 lesion, and stage III disease are statistically significant factors associated with positive CRM in patients with rectal cancer. Identifying these factors will enable surgeons to plan treatment through interdisciplinary care and reduce the risk of positive CRM, which will ultimately improve overall survival and long-term quality of life for patients.
References
Saeng-ariyawanich A, Pitakkankul S, Buasom R, editors. Hospital-level cancer registry 2020. Bangkok: Cancer Records and Database Unit, Digital Medical Affairs Division, National Cancer Institute; 2021.
Kobayashi H, Mochizuki H, Sugihara K, Morita T, Kotake K, Teramoto T, et al. Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study. Surgery 2007;141(1):67-75.
Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 2008;26(2):303-12.
Wibe A, Møller B, Norstein J, Carlsen E, Wiig JN, Heald RJ, et al. A national strategic change in treatment policy for rectal cancer--implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum 2002;45(7):857-66.
Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997. Arch Surg 1998;133(8):894-9
Martling AL, Holm T, Rutqvist LE, Moran BJ, Heald RJ, Cedemark B. 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 2000;356(9224):93-6.
Park JS, Huh JW, Park YA, Cho YB, Yun SH, Kim HC, et al. A circumferential resection margin of 1 mm is a negative prognostic factor in rectal cancer patients with and without neoadjuvant chemoradiotherapy. Dis Colon Rectum 2014;57(8):933-40.
Martling A, Cedermark B, Johansson H, Rutqvist LE, Holm T. The surgeon as a prognostic factor after the introduction of total mesorectal excision in the treatment of rectal cancer. Br J Surg 2002;89(8):1008-13.
Patel SH, Hu CY, Massarweh NN, You YN, McCabe R, Dietz D, et al. Circumferential resection margin as a hospital quality assessment tool for rectal cancer surgery. J Am Coll Surg 2020;230(6):1008-18.e5.
Burton S, Brown G, Daniels IR, Norman AR, Mason B, Cunningham D; Royal Marsden Hospital, Colorectal Cancer Network. MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins? Br J Cancer 2006;94(3):351-7.
Hall NR, Finan PJ, al-Jaberi T, Tsang CS, Brown SR, Dixon MF, et al. Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence? Dis Colon Rectum 1998;41(8):979-83.
Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 1986;2(8514):996-9.
Krishnamurty DM, Wise PE. Importance of surgical margins in rectal cancer. J Surg Oncol 2016;113(3): 323-32.
Kang BM, Park YK, Park SJ, Lee KY, Kim CW, Lee SH. Does circumferential tumor location affect the circumferential resection margin status in mid and low rectal cancer? Asian J Surg 2018;41(3):257-63.
Sugimoto K, Takahashi H, Yuki 2nd, Irie T, Kawaguchi M, Kobari A, et al. Positive circumferential resection margin in rectal cancer Is a robust predictor of poor long-term prognosis with clinicopathological bias between groups compensated by Propensity-score Matching Analysis. Anticancer Res 2023;43(8):3623-30.
National Comprehensive Cancer Network. Colon Cancer. [Internet]. 2024 [cited 2024 Dec 31]. Available from: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1428
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996;49(12):1373-9.
Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 2007;165(6):710-8.
Wang C, Zhou ZG, Yu YY, Shu Y, Li Y, Yang L, et al. Occurrence and prognostic value of circumferential resection margin involvement for patients with rectal cancer. Int J Colorectal Dis 2009;24(4):385-90.
Bernstein TE, Endreseth BH, Romundstad P, Wibe A; Norwegian Colorectal Cancer Group. Circumferential resection margin as a prognostic factor in rectal cancer. Br J Surg 2009;96(11):1348-57.
Ferrari L, Fichera A. Neoadjuvant chemoradiation therapy and pathological complete response in rectal cancer. Gastroenterol Rep (Oxf) 2015;3(4):277-88.
Tilney HS, Tekkis PP, Sains PS, Constantinides VA, Heriot AG; Association of Coloproctology of Great Britain and Ireland. Factors affecting circumferential resection margin involvement after rectal cancer excision. Dis Colon Rectum 2007;50(1):29-36.
Detering R, Saraste D, de Neree Tot Babberich MPM, Dekker JWT, Wouters MWJM, van Geloven AAW, et al. International evaluation of circumferential resection margins after rectal cancer resection: insights from the Swedish and Dutch audits. Colorectal Dis 2020;22(4):416-29.
Hiranyakas A, da Silva G, Wexner SD, Ho YH, Allende D, Berho M. Factors influencing circumferential resection margin in rectal cancer. Colorectal Dis 2013;15(3):298-303.
Birbeck KF, Macklin CP, Tiffn NJ, Parsons W, Dixon MF, Mapstone NP, et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 2002;235(4):449-57.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Department of Medical Services, Ministry of Public Health
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของกรมการแพทย์ กระทรวงสาธารณสุข
ข้อความและข้อคิดเห็นต่างๆ เป็นของผู้เขียนบทความ ไม่ใช่ความเห็นของกองบรรณาธิการหรือของวารสารกรมการแพทย์
