title: Rectal cancer: involved circumferential resection margin - a root cause analysis.
abstract: BACKGROUND
  An involved circumferential resection margin (CRM) following surgery for rectal cancer is the strongest predictor of local recurrence and may represent a failure of the multidisciplinary team (MDT) process.
  
  
  OBJECTIVE
  The study analyses the causes of positive CRM in patients undergoing elective surgery for rectal cancer with respect to the decision-making process of the MDT, preoperative rectal cancer staging and surgical technique.
  
  
  METHODS
  From March 2002 to September 2005, data were collected prospectively on all patients undergoing elective rectal cancer surgery with curative intent. The data on all patients identified with positive CRM were analysed.
  
  
  RESULTS
  Of 158 patients (male:female = 2.2:1) who underwent potentially curative surgery, 16 (10%) patients had a positive CRM on postoperative histology. Four were due to failure of the pelvic magnetic resonance imaging (MRI) staging scans to predict an involved margin, two with an equivocal CRM on MRI did not have preoperative radiotherapy, one had an inaccurate assessment of the site of primary tumour and in one intra-operative difficulty was encountered. No failure of staging or surgery was identified in the remaining eight of the 16 patients. Abdominoperineal resection (APR) was associated with a 26% positive CRM, compared with 5% for anterior resection.
  
  
  CONCLUSIONS
  No single consistent cause was found for a positive CRM. The current MDT process and/or surgical technique may be inadequate for low rectal tumours requiring APR.
authors.affiliation: University Hospital Birmingham, Queen Elizabeth Medical Centre, Birmingham, UK. haney@doctors.org.uk
authors.forename: H
authors.initials: H
authors.lastname: Youssef
authors.forename: E C
authors.initials: EC
authors.lastname: Collantes
authors.forename: S H
authors.initials: SH
authors.lastname: Rashid
authors.forename: L S
authors.initials: LS
authors.lastname: Wong
authors.forename: P
authors.initials: P
authors.lastname: Baragwanath
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003657:Decision Making; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery; D012007:Rectum / Q000473:pathology* / Q000601:surgery