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The Pathological Assessment of Total Mesorectal Excision: What Are the Relevant Resection Margins?

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Rectal Cancer Treatment

Part of the book series: Recent Results in Cancer Research ((RECENTCANCER,volume 165))

Abstract

An accurate pathological reporting of rectal cancer specimens has important implications concerning patients' prognosis and further clinical management. Since locoregional recurrence and prognosis in rectal cancer is especially influenced by the extent of extramural tumor spread into the mesorectal lymphovascular fatty tissue, systematic investigation of the status of the circumferential mesorectal resection margin is a point of major importance to determine the completeness of tumor resection. Careful macroscopic assessment of the resection specimen should be performed to monitor the quality of mesorectal excision.

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References

  • Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D, Dixon MF, Quirke P (1994) Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 344:707–711

    PubMed  Google Scholar 

  • Birbeck KF, Macklin CP, Tiffin MJ, Parsons W, Dixon MF, Finan PJ, Johnston D, Quirke P (2002) Rates of circumferential margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 235:449–457

    Article  PubMed  Google Scholar 

  • Cawthorn SJ, Parums DV, Gibbs NM, A'Hern RP, Caffarey SM, Broughton CIM, Marks CG (1990) Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer. Lancet 335:1055–1059

    Article  PubMed  Google Scholar 

  • Compton C, Fenoglio-Preiser CM, Pettigrew N, Fielding LP (2000) American Joint committee on cancer prognostic factors consensus conference-colorectalworking group. Cancer 88:1739–1757

    Article  PubMed  Google Scholar 

  • DeHaas-Kock DFM, Baeten CGMI, Jager JJ, Langendijk JA, Schouten LJ, Volovics A, Arends JW (1996) Prognostic significance of radial margins of clearance in rectal cancer. Br J Surg 83:781–785

    PubMed  Google Scholar 

  • Hall NR, Finan PJ, Al-Jaberi T, Tsang CS, Brown SR, Dixon MF, Quirke P (1998) Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence? Dis Colon Rectum 41:979–983

    PubMed  Google Scholar 

  • Goldstein N, Soman A, Sacksner J (1999) Disparate surgical margin lengths of colorectal resection specimens between in vivo and in vitro measurements. Anat Pathol 111:349–351

    Google Scholar 

  • Heald RJ (1988) The holy plane of rectal surgery. J Royal Soc Med 81:503–508

    Google Scholar 

  • Heald RJ, Ryall RDH (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482

    PubMed  Google Scholar 

  • Heald RJ, Husband EM, Ryall RDH (1982) The mesorectum in rectal cancer surgery-the clue to pelvic recurrence? Br J Surg 69:613–616

    PubMed  Google Scholar 

  • Heald RJ, Moran BJ, Ryall RDH, Sexton R, MacFarlane JK (1998) Rectal cancer. The Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133:894–899.

    Article  PubMed  Google Scholar 

  • Hermanek P, Gall FP (1981) Der aborale Sicherheitsabstand bei der sphinctererhaltenden Rektumresektion. Chirurg 52:25–29

    Google Scholar 

  • Hermanek P, Guggenmoos-Holzmann, Gall FP (1989) Prognostic factors in rectal carcinoma. A contribution to the further development of tumor classification. Dis Colon Rectum 32:593–599

    PubMed  Google Scholar 

  • Hermanek P, Wiebelt H, Riedl S, Staimmer D, Hermanek P, und die Studiengruppe Kolorektales Karzinom (SGKRK) (1994) Langzeitergebnisse der chirurgischen Therapie des Coloncarcinoms. Ergebnisse der Studiengruppe Kolorektales Karzinom (SGKRK). Chirurg 65:287–297

    PubMed  Google Scholar 

  • Hermanek P, Wiebelt H, Staimmer D, Riedl S, and the German Study Group Colo-Rectal Carcinoma (SGCRC) (1995) Prognostic factors of rectum carcinoma-experience of the German multicentre study SGCRC. Tumori 81 Supplement:60–64

    Google Scholar 

  • Hermanek P, Hermanek P Hohenberger W, Klimpfinger M, Köckerling F, Papadopoulos T (2003) The pathological assessment of mesorectal excision: implications for further treatment and quality management. Int J Colorectal Dis 18:335–341

    PubMed  Google Scholar 

  • Hohenberger W, Schick CH, Göhl J (1998) Mesorectal lymph node dissection: is it beneficial? Langenbeck's Arch Surg 383:402–408

    Article  Google Scholar 

  • Jass JR, Atkin WS, Cuzick J, Bussey HJ, Morson BC, Northover JM, Todd IP (1986) The grading of rectal cancer: historical perspectives and amultivariate analysis of 447 cases. Histopathology 10:437–459

    PubMed  Google Scholar 

  • Kapiteijn E, Marijnen CAM, Nagtegaal D, Putter H, Steup WH, Wiggers T, Rutten HJT, Pahlmann L, Glimelius B, Van Krieken HJM, Leer JWH, Van de Velde CJH, for the Dutch Colorectal Cancer Group (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646

    PubMed  Google Scholar 

  • Köckerling F, Reymond MA, Alterdorf-Hofmann A, Dworak O, Hohenberger W (1988) Influence of Surgery on metachronous distant metastases and survival in rectal cancer. J Clin Oncol 16:324–329

    Google Scholar 

  • Kwok SPY, Lau WY, Leung KL, Liew CT, Li AKC (1996) Prospective analysis of the distal margin of clearance in anterior resection for rectal carcinoma. Br J Surg 83:969–972

    PubMed  Google Scholar 

  • Maurer CA, Renzulli P, Meyer JD, Büchler MW (1999) Rektumkarzinom. Optimierung durch partielle oder totale Mesorektumentfernung. Zentralbl Chir 124:428–435

    PubMed  Google Scholar 

  • MacFarlane JK, Ryall RDH, Heals RJ (1993) Mesorectal excision for rectal cancer. Lancet 341:457–460.

    Article  PubMed  Google Scholar 

  • Nagtegaal ID, Van Krieken JHJM (2002) The role of the pathologist in the quality control of diagnosis and treatment of rectal cancer-an overview. Eur J Cancer 38:964–972

    Article  PubMed  Google Scholar 

  • Nagtegaal ID, Marijnen CAM, Kranenbarg EK, Van de Velde CJH, Van Krieken JHJM, for the Pathology Review Committee and the Cooperative Clinical Investigators (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 Pathol 26:350–357

    Article  Google Scholar 

  • Nagtegaal ID, Van de Velde CJH, Van der Worp E, Kapiteijn E, Quirke P, Van Krieken JHJM, and the Pathology Review Committee for the Cooperative Clinical Investigators of the Dutch Colorectal Cancer Group (2002)Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20:1729–1734

    Article  PubMed  Google Scholar 

  • Ng IOL, Luk ISC, Yuen ST, Lau PWK, Pritchett CJ, Ng M, Poon GP, Ho J (1993) Surgical lateral clearance in resected rectal carcinomas. Amultivariate analysis of clinicopathologic features. Cancer 71:1972–1976

    PubMed  Google Scholar 

  • Phillips RKS, Hittinger R, Blesovsky L, Fry JS, Fielding LP (1984) Local recurrence following curative surgery for large bowel cancer: II. The rectum and rectosigmoid. Br J Surg 71:17–20

    PubMed  Google Scholar 

  • Pollett WG, Nicholls RJ (1983) The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg 198:159–163

    PubMed  Google Scholar 

  • Quirke P (1998) The pathologist, the surgeon and colorectal cancer-get it right because it matters. Progress Pathol 4:201–213

    Google Scholar 

  • Quirke P, Dixon MF (1988) How I do it. The prediction of local recurrence in rectal adenocarcinoma by histopathological examination. Int J Colorect Dis 3:127–131

    Article  Google Scholar 

  • Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2:996–999

    Article  PubMed  Google Scholar 

  • Riedl S, Wiebelt H, Bergmann U, Hermanek P (1995) Postoperative Komplikationen und Letalität in der chirurgischen Therapie des Coloncarcinoms. Ergebnisse der deutschen Multizenterstudie der Studiengruppe Kolorektales Karzinom (SGKRK). Chirurg 66:597–606

    PubMed  Google Scholar 

  • Scott N, Jackson P, Al-Jaberi T, Dixon MF, Quirke P, Finan PF (1995) Total mesorectal excision and local recurrence: a study of tumour spread in the mesorectum distal to rectal cancer. Br J Surg 82:1031–1033

    PubMed  Google Scholar 

  • Shirouzu K, Isomoto H, Kakegawa T (1995) Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery. Cancer 76:388–92

    PubMed  Google Scholar 

  • Vernava AM, Moran M (1992) A prospective evaluation of distal margins in carcinoma of the rectum. Surg Gynecol Obstet 163:101–103

    Google Scholar 

  • Wibe A, Eriksen MT, Syse A, Myrvold HE, Soreide O. on behalf of the Norwegian Rectal Cancer Group (2002) Totalmesorectal excision for rectal cancer-what can be achieved by a national audit? Colorectal Disease 5:471–477

    Article  Google Scholar 

  • Wibe A, Rendedal PR, Svensson E, Norstein J, Eide TJ, Myrvold HE, Soreide O, on behalf of the Norwegian Rectal Cancer Group (2002) Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg 89:327–334

    Article  PubMed  Google Scholar 

  • Williams NS, Dixon MF, Johnston D (1983) Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients' survival. Br J Surg 70:150–154

    PubMed  Google Scholar 

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Autschbach, F. (2005). The Pathological Assessment of Total Mesorectal Excision: What Are the Relevant Resection Margins?. In: Büchler, M.W., Weitz, J., Ulrich, B., Heald, R.J. (eds) Rectal Cancer Treatment. Recent Results in Cancer Research, vol 165. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-27449-9_5

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  • DOI: https://doi.org/10.1007/3-540-27449-9_5

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-23341-1

  • Online ISBN: 978-3-540-27449-0

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