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Predictors of Dumont et al for a Positive Circumferential Margin Following Chemoradiotherapy and Sphincter-Sparing Surgery for a Low Rectal Cancer

Description

Dumont et al identified factors associated with a positive circumferential margin (CRM) after chemoradiation and sphincter-sparing surgery for low rectal cancer. These can help to identify a patient who may require an alternative surgical approach. The authors are from Gustave Roussy Cancer Campus in Villejuif, France.


Patient selection: low rectal cancer

 

Outcome: positive circumferential margin with sphincter-sparing surgery (cancer cells at or within 1 mm of surgical margin)

 

Predictors of a positive margin:

(1) tumor diameter > 3 cm

(2) poor response to chemoradiation by tumor regression grading (TRG)

(3) fixed tumor

 

where:

• A good response to chemoradiation is no viable cancer cells (TRG 0) or single or small groups of cancer cells (TRG 1).

• A poor response is residual cancer with fibrosis (TRG 2) or minimal or no response (TRG 3).

 

Number of Predictive Factors

Percent with Positive Margin

0 or 1

1.3%

2 or 3

50%

 

The surgical alternative is an abdominoperineal resection with a permanent stoma.


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