Abstract
Background Malignant involvement of circumferential resection margin (CRM) and longitudinal resection margin (LRM) after surgical resection of colorectal cancer (CRC) are associated with higher rates of recurrence and development of distant metastasis. This can influence the overall patient's prognosis. The aim of the current study was to identify pathological factors as predictors for the involvement of resection margins in early T3 CRC. Patients and Methods. Fifty patients radiologically diagnosed to have cT3a/b (CRC) were included in the study. After resection, the pathological examination was performed to identify patients with positive CRM and/or LRM. Relations between the different pathological parameters and the CMR and LRM involvements were assessed. Results Positive CRM was present in 17 cases (34%), while positive LRM was found in 6 cases (12%). The involvement of both margins was significantly associated with rectal tumors and tumors with infiltrative gross appearance, grade III, deeper invasion, and positive lymph node metastases. Also, there was a significant association between both margins' positivity and other pathological parameters as signet ring carcinoma, tumor budding, perineural and vascular invasion, high microvessel density (MVD), and sinusoidal vascular pattern, while the presence of necrosis and infiltrative advancing tumor front was significantly associated with CRM involvement only. The depth of tumor invasion and signet ring carcinoma were identified as independent predictor factors for positive CRM and LRM, respectively. Conclusion Preoperative identification of these pathological parameters can be a guide to tailor the management plan accordingly.
Highlights
Colorectal Cancer (CRC) is the third most commonly diagnosed cancer and the second cancer-related leading cause of death [1]
In a meta-analysis that included over 17,000 patients, Nagtegaal and Quirke [20] were able to demonstrate that involvement of circumferential resection margin (CRM) was a strong predictor of local recurrence (HR 2.7, 95 percent confidence intervals (95% CI) 1.7–4.3), distant metastases (HR 2.8, 95% CI 1.9–4.3), and survival as well (HR 1.7, 95% CI 1.3–2.3)
For the colon, longitudinal resection margin (LRM) had great attention in research neglecting the significance of its radial margin
Summary
Malignant involvement of circumferential resection margin (CRM) and longitudinal resection margin (LRM) after surgical resection of colorectal cancer (CRC) are associated with higher rates of recurrence and development of distant metastasis. E aim of the current study was to identify pathological factors as predictors for the involvement of resection margins in early T3 CRC. The pathological examination was performed to identify patients with positive CRM and/or LRM. E involvement of both margins was significantly associated with rectal tumors and tumors with infiltrative gross appearance, grade III, deeper invasion, and positive lymph node metastases. There was a significant association between both margins’ positivity and other pathological parameters as signet ring carcinoma, tumor budding, perineural and vascular invasion, high microvessel density (MVD), and sinusoidal vascular pattern, while the presence of necrosis and infiltrative advancing tumor front was significantly associated with CRM involvement only. E depth of tumor invasion and signet ring carcinoma were identified as independent predictor factors for positive CRM and LRM, respectively. Preoperative identification of these pathological parameters can be a guide to tailor the management plan
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