Researchers from Leeds, England, analyzed the potential variability in rates of circumferential resection margin (CRM) involvement between different surgeons and time periods.
They also determined the suitability of using CRM status as an immediate predictor of outcome after rectal cancer surgery.
The study involved 608 patients who underwent surgery for rectal cancer in Leeds during the 12-year period, 1986 to 1997.
Of 586 patients on whom full clinical follow-up was obtained, 28% had CRM involvement by carcinoma on pathologic examination.
The team found that, up to the end of 1998, 18% patients had developed local recurrence.
A significantly higher proportion (38%) of CRM-positive patients developed local recurrence than CRM-negative ones (10%).
|Local rectal cancer recurrence:|
CRM-positive patients: 38%
CRM-negative patients: 10%
| Annals of Surgery |
Kaplan-Meier survival analysis showed significant improvements in survival for CRM-negative patients over CRM-positive patients.
Survival analysis, in relation to two gastrointestinal surgeons and a group of other surgeons, was conducted.
This showed survival improvements that paralleled a reduction in the rates of CRM involvement for the two gastrointestinal surgeons during the period of the study.
No improvement in survival or reduction in rates of CRM involvement was seen in the group of other surgeons.
Kevin F. Birbeck, of the Leeds Teaching Hospitals NHS Trust, said on behalf of his group, "These results show that CRM status may be used as an immediate predictor of survival after rectal cancer surgery and serves as a useful indicator of the quality of surgery."
"The frequency of CRM involvement can be used both for overall surgical audit and for monitoring the value of training programs in improving rectal surgery by individual surgeons," he added.
"Its use in the current MRC CR07 study is valid and the best indicator of a requirement for further local therapy," he concluded.