title: Objective measurement of the distal resection margin by MRI of the fresh and fixed specimen after partial mesorectal excision for rectal cancer: 5 cm is not just 5 cm and depends on when measured.
abstract: BACKGROUND
  Most studies have directly established the optimal perioperative in situ clearance margin in surgery for rectal cancer from the histologically observed extent of distal spread, neglecting the tissue variability that occurs after resection and fixation of the rectal specimen.
  
  
  OBJECTIVE
  To measure the length of the distal resection margin in the fresh and fixed specimen following partial mesorectal excision for rectal cancer using magnetic resonance imaging (MRI) to document tissue shrinkage after surgical removal and fixation.
  
  
  METHODS
  The length of the distal resection margin was measured by MRI of the fresh and fixed specimen and at histopathological examination of the fixed specimen in 10 patients who underwent surgery for upper rectal cancer. In addition, tissue shrinkage was estimated by measuring the total length of the fresh and fixed specimen and distance from the peritoneal reflection anteriorly to the distal cut edge of the specimen.
  
  
  RESULTS
  Measured by MRI, the distal resection margin was in the range of 0.6-10.2 cm (mean, 4.6 cm) in the fresh specimen, and 0.5-6.2 cm (mean, 3.2 cm) in the fixed specimen. The tissue shrinkage ratio was a mean of 69% (interquartile range, 61-77%). Taking all ratios from MRI and histopathological examination of tissue shrinkage into account, the collective tissue shrinkage ratio was 70% (95% confidence interval, 67-73%)
  
  
  CONCLUSIONS
  The length of the distal resection margin was reduced by 30% after surgical removal and fixation of the specimen.
authors.affiliation: Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark Department of Radiology, Aarhus University Hospital, Aarhus, Denmark petefred@rm.dk.
authors.forename: Peter
authors.initials: P
authors.lastname: Bondeven
authors.affiliation: Department of Pathology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Rikke H
authors.initials: RH
authors.lastname: Hagemann-Madsen
authors.affiliation: Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lise
authors.initials: L
authors.lastname: Bro
authors.affiliation: Colorectal Surgery, Hampshire Hospitals Foundation Trust, Basingstoke, UK.
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Moran
authors.affiliation: Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Laurberg
authors.affiliation: Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Bodil Ginnerup
authors.initials: BG
authors.lastname: Pedersen
mesh_terms: D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D000072662:Margins of Excision; D009367:Neoplasm Staging; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*
keywords: Abdomen/GI; magnetic resonance imaging (MRI); neoplasms – primary; rectum