The circumferential resection margin in rectal carcinoma surgery.
After radical resection of rectal carcinoma, the circumferential resection margin (CRM) on the non-peritonealized surface of the resected specimen is of critical importance. Histopathological examination of resected specimens must include careful assessment of the CRM. There is a need to distinguish between CRM-positive (CRM directly involved by tumor or minimal distance between tumor and CRM 1 mm or less) and CRM-negative (distance between tumor and CRM more than 1 mm) situations. Optimized surgery (so-called TME surgery) and an experienced surgeon decrease the frequency of CRM-positive specimens. The CRM status is an important predictor of local and distant recurrence as well as survival. The CRM status can be reliably predicted by preoperative thin-slice high-resolution magnetic resonance imaging (MRI). In the event of predicted CRM-positivity, neoadjuvant radiochemotherapy is indicated.
Hermanek
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P
Department of Surgery, University of Erlangen, 3560, D-91023 Erlangen, Germany. susanne.merkel@chir.imed.uni-erlangen.de
Junginger
T
T
D001707:Biopsy, Needle; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003113:Colonoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D020360:Neoadjuvant Therapy / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome