Circumferential resection margin in the modern treatment of rectal cancer


Authors: P. Ihnát;  L. Martínek 1,2;  L. Ihnát Rudinská 1,2;  M. Mitták 3;  P. Vávra 1,2;  P. Zonča 1,2 1,2
Authors‘ workplace: Katedra chirurgických oborů, Lékařská fakulta Ostravské Univerzity vedoucí katedry: Doc. MUDr. P. Zonča, Ph. D., FRCS 1;  Chirurgická klinika, FN Ostrava, přednosta: Doc. MUDr. P. Zonča, Ph. D., FRCS 2;  Ústav soudního lékařství, FN Ostrava, přednosta: MUDr. I. Dvořáček, Ph. D. 3
Published in: Rozhl. Chir., 2013, roč. 92, č. 6, s. 297-303.
Category: Review

Overview

Introduction:
In the last decades, the assessment of circumferential resection margin (CRM) has gained enormous importance in the management of patients with rectal carcinoma, not only in predicting the prognosis, but also in precise cancer staging, in multimodal treatment indications and in quality assessment of provided care.

Methods:
The authors present a review article containing CRM definition, describing the technique of CRM assessment, the effect of CRM status on the prognosis and quality of provided therapy. CRM assessment in the context of a multidisciplinary team is especially emphasised. The aspect of CRM has to be considered by the radiologist during cancer staging, the surgeon in the course of the operation, the pathologist during precise macroscopic and histopathological specimen evaluation, and the oncologist when deciding on neoadjuvant/adjuvant therapy administration.

Conclusion:
CRM nowadays represents a fundamental aspect in modern treatment of patients with rectal carcinoma. The introduction of CRM assessment into clinical practice has lead to more precise staging, better multimodal therapy indications, more precise surgical technique (total mesorectal excision), an increased rate of sphincter-saving resections, lowered local recurrence rates and improved patient survival.

Key words:
rectal carcinoma – circumferential resection margin – total mesorectal excision – multidisciplinary approach


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Surgery Orthopaedics Trauma surgery
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