Surgical lateral clearance in resected rectal carcinomas: A multivariate analysis of clinicopathologic features

✍ Scribed by R. J. Heald; J. K. Macfarlane; R. D. H. Ryall

• Publisher: John Wiley and Sons
• Year: 1993
• Tongue: English
• Weight: 77 KB
• Volume: 72
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/1097-0142(19930901)72:5<1806::aid-cncr2820720548>3.0.co;2-k

✦ Synopsis

We applaud the attention focused on the lateral margins of rectal cancer excision specimens by Ng et al.' Similar findings were reported in the Lancet in 1986 by Quirke et a1.' and again this year by Quirke3 from Leeds, where a multisurgeon series produced an even higher local recurrence rate. This in turn reflected a high rate of lateral margin involvement (LMI), giving high specificity, sensitivity, and predictive value of LMI for local recurrence. Interestingly, Cawthorne et al. from Guildford failed totally to reproduce these fig~res.~ An editorial in the Lancet at that time explained this by suggesting that their specimens were from a single surgeon who was attempting to excise the mesorectum as a complete package, that is, performing what we have called a total mesorectal excision (TME).5*6 This had produced a 7% local recurrence rate in the Guildford series, none predicted by LMI, whilst those specimens with LMI were from patients who died rapidly of metastases. The editorial deduced that most of the Leeds cases with involved margins were the consequence of incomplete mesorectal excision, which is common with conventional surgical techniques. Furthermore, it appeared that involvement of the lateral margins of a properly excised mesorectum rarely occurred, except in tumors that had already metastasized. The editor suggested that LMI predicted preventable local recurrences and could be used by pathologists to audit the quality of the surgical specimen. We believe our recently published figures of 4% for local recurrence after curative anterior resection reflect a low incidence of involved margins because of careful and complete removal of a tumor package comprising the whole integral visceral mesentery of the rectum (TME).' This concept further underpins the importance of Ng et al.'s paper, because the principles it addresses point the way to more actual "cures" of cancer.