Department of General Surgery, Colorectal Surgery Unit, Rambam Health Care Campus, and Bruce Rappaport School of Medicine, The Technion, Haifa, Israel.
J Surg Oncol. 2014 Dec;110(8):997-1001. doi: 10.1002/jso.23758. Epub 2014 Sep 2.
Distal margin >1 cm provides an oncologic safety in low-lying rectal cancers. We evaluated the accuracy of frozen section (FS) examination in estimating distal margins, and its impact on intraoperative decision making regarding restorative proctectomy.
Retrospective study of patients who underwent surgery for adenocarcinoma of the mid or lower rectum during 2001-2010 and for whom a distal margin specimen was examined intraoperatively by FS, to confirm microscopically free margins. Intraoperative findings, and frozen and final paraffin section findings were retrieved from patient charts. A distal margin of ≤1 cm was compared with >1 cm, for free margins at final pathology and local recurrence (LR). The impact of a distal margin ≤5 mm was also assessed. The impact of FS on intraoperative decision making, in patients who did and did not receive preoperative chemoradiotherapy, was assessed.
The mean age of the 63 patients studied was 66.4 ± 11.8 years, and median tumor distance from the anal verge 6 cm (range 1-10 cm). Seven patients underwent abdominoperineal resection, 54 anterior resection, and two Hartman procedures. FS sensitivity and specificity were 83% and 98%, respectively. Accuracy of FS was high for the 41 patients treated with preoperative chemoradiotherapy, and the 22 who were not. Distal margin >5 mm at FS examination ensured a free margin at final pathology. LR rate was comparable between patients with distal margin >10 mm and ≤10 mm, 8% vs 11%, P = 0.65.
FS examination may help determine free distal margin and consequently, in selected cases, may facilitate a restorative procedure in patients with low rectal cancer.
低位直肠癌的远端切缘>1cm 可提供肿瘤学安全性。我们评估了冰冻切片（FS）检查在估计远端切缘中的准确性，及其对中低位直肠腺癌患者行直肠全系膜切除术中决策的影响。
回顾性分析 2001-2010 年间接受中低位直肠腺癌手术的患者，术中行 FS 检查以确认远端切缘标本的显微镜下无肿瘤边缘。从患者病历中获取术中所见、FS 和石蜡切片最终结果。比较最终病理和局部复发（LR）时远端切缘≤1cm 和>1cm 的游离边缘。还评估了远端切缘≤5mm 的影响。评估 FS 对接受和未接受术前放化疗患者术中决策的影响。
研究的 63 例患者平均年龄为 66.4±11.8 岁，肿瘤距肛门距离中位数为 6cm（范围 1-10cm）。7 例行腹会阴联合切除术，54 例行前切除术，2 例行 Hartman 手术。FS 的敏感性和特异性分别为 83%和 98%。术前放化疗的 41 例和未接受术前放化疗的 22 例患者的 FS 准确率较高。FS 检查时远端切缘>5mm 可确保最终病理时无肿瘤边缘。远端切缘>10mm 和≤10mm 的患者 LR 率相似，分别为 8%和 11%，P=0.65。
FS 检查有助于确定远端无肿瘤边缘，从而在选择病例中，为低位直肠癌患者提供辅助性保肛手术。
