European Cancer Summit 2022 submission for Quality Cancer Care NetworkVariations in the definition and perceived importance of positive resection margins in patients with colorectal cancer: a survey study

Abstract

BackgroundMicroscopically positive resection margins (R1) have a well-recognized association with poorer outcomes in patients with colorectal cancer. However, different definitions of positive margins have been proposed and it is currently unclear to what extent these definitions used in everyday clinical practice differ both within and between nations. This study sought to investigate variations in the definition of positive margins in colorectal cancer and the importance of margin status in clinical decision making. MethodsA prospective survey-based study conducted by The European Society of Surgical Oncology (ESSO) Young Surgeons and Alumni Club (EYSAC) Research Academy. A 14-point survey was developed and distributed via social media and ESSO’s newsletter in June 2022. The survey was aimed at any clinician involved in colorectal cancer care. ResultsA total of 120 responses were received, the majority from surgeons (53.3%) and from European nations (89.2%). The most commonly reported definition of positive resection margin was the presence of cancer cells within ≤ 1mm of the margin, although less than 2/3 of respondents use this definition. 23.9% of respondents stated that pathology reports are not routinely reviewed at MDT meetings. Less than half (46.7%) reported that positive margins were a factor used to determine the type and duration of adjuvant chemotherapy, with variations also noted in other histopathological factors such a T stage, N stage and mismatch repair (MMR) status. ConclusionThe results of this survey suggest that significant variations in the definition and perceived clinical importance of positive margins in colorectal cancer exist. Development and acceptance of a uniform definition of positive margins is necessary and further work must be done to incorporate the presence of positive margins into decision making with regard to adjuvant chemotherapy.