title: The retroperitoneal surface in distal caecal and proximal ascending colon carcinoma: the Cinderella surgical margin?
abstract: BACKGROUND
  Mesorectal margin tumour involvement is a predictor of local recurrence in rectal carcinoma and an indication for postoperative radiotherapy in suitable patients. However, the prevalence of non-peritonealised surgical margin involvement in ascending colon carcinoma is unknown.
  
  
  OBJECTIVE
  To test the hypothesis that retroperitoneal surgical margin (RSM) tumour involvement occurs in distal caecal and proximal ascending colon carcinoma.
  
  
  RESULTS
  One hundred right hemicolectomy specimens, removed for adenocarcinoma of the caecum or proximal ascending colon, were studied. During routine specimen dissection, at least one additional tissue block was taken to include the tumour and the RSM. The tumour distance from the RSM was recorded. RSM tumour involvement was present in seven cases (7%). Direct (non-nodal) RSM tumour involvement (five cases) only occurred in posterior or circumferential tumours.
  
  
  CONCLUSIONS
  RSM tumour involvement occurs within a considerable number of distal caecal and proximal ascending colon carcinomas. The rate of RSM tumour involvement identified here is similar to a previously published local recurrence rate of 10% in caecal carcinoma, suggesting that RSM tumour involvement may be a predictor of recurrence in these tumours. Therefore, patients with distal caecal or proximal ascending colon carcinoma and RSM tumour involvement may benefit from postoperative radiotherapy.
authors.affiliation: Department of Cellular Pathology, Southampton University Hospitals NHS Trust, Southampton S016 6YD, UK. adrian.bateman@suht.swest.nhs.uk
authors.forename: A C
authors.initials: AC
authors.lastname: Bateman
authors.forename: N J
authors.initials: NJ
authors.lastname: Carr
authors.forename: B F
authors.initials: BF
authors.lastname: Warren
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D002430:Cecal Neoplasms / Q000473:pathology* / Q000601:surgery; D002432:Cecum / Q000473:pathology*; D044682:Colon, Ascending / Q000473:pathology*; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000473:pathology; D012187:Retroperitoneal Space