Rectal cancer margins

Distal margins.
- traditionally 5 cm. However no difference in local recurrence rateswhethwr 5, 2 or <2 cm distal margins.

Current recommendations. NCI
- proximal margin 5cm
- distal margin of >= 2 cm
- however, if 1cm margin needed to preserve sphincters then acceptable.
- distal spread beyond 1cm associated with aggressive disease or advanced stage tumors and a longer distal margin will not improve prognosis.

CRM: circumferential radial margin.
- most important determinant of local recurrence.
- TME has largely ensured that adequate circumferential margins routinely obtained.
- preTME era local recurrence was in the realm of 15-30%
- now recurrence rates should strive for 4-7%
- if mesorectal margin involved then local recurrence rates 11 vs 5%

Nodal clearance:
- 12 LNs required for adequate pathological staging. NCCN.
- can be challenging in pts who have had neoadjuvant therapy.

- Posted using BlogPress from my iPhone