Division of General Surgery, Section of Colon & Rectal Surgery, Vanderbilt University, Nashville, Tennessee.
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
J Surg Res. 2024 Apr;296:532-540. doi: 10.1016/j.jss.2023.12.047. Epub 2024 Feb 8.
Circumferential resection margin (CRM) is a key quality metric and predictor of oncologic outcomes and overall survival following surgery for rectal cancer. We aimed to develop a nomogram to identify patients at risk for a positive CRM in the preoperative setting.
We performed a retrospective evaluation of the National Cancer Database from 2010 to 2014 for patients with clinical stage I-III rectal cancer who underwent total mesorectal excision. Patients were excluded for emergency operation, resection for cancer recurrence, palliative resection, transanal resection, and missing CRM status. The primary outcome was positive CRM. Secondary outcomes included overall survival.
There were 28,790 patients included. 2245 (7.8%) had a positive CRM. Higher tumor grade, lack of neoadjuvant chemotherapy, mucinous/signet tumor histology, open approach, abdominoperineal resection, higher T stage, lymphovascular invasion, and perineural invasion were all significantly associated with positive CRM (P < 0.05) and were included in the nomogram. The C-statistic was 0.703, suggesting a good predictive model.
Positive CRM is associated with specific patient demographics and tumor characteristics. These factors can be used along with preoperative MRI to predict CRM positivity in the preoperative period and plan accordingly.
环周切缘（CRM）是直肠癌手术的关键质量指标和肿瘤学结果及总生存的预测因素。我们旨在建立一个列线图，以识别术前存在 CRM 阳性风险的患者。
我们对 2010 年至 2014 年国家癌症数据库中接受全直肠系膜切除术的临床 I-III 期直肠癌患者进行了回顾性评估。排除急诊手术、癌症复发切除、姑息性切除、经肛门切除术和 CRM 状态缺失的患者。主要结局是 CRM 阳性。次要结局包括总生存。
共纳入 28790 例患者。2245 例（7.8%）存在 CRM 阳性。更高的肿瘤分级、缺乏新辅助化疗、黏液/印戒细胞肿瘤组织学、开放性手术、腹会阴切除术、更高的 T 分期、淋巴血管侵犯和神经周围侵犯均与 CRM 阳性显著相关（P<0.05），并被纳入列线图。C 统计量为 0.703，表明预测模型良好。
CRM 阳性与特定的患者人口统计学和肿瘤特征相关。这些因素可以与术前 MRI 一起用于预测术前的 CRM 阳性，并相应地进行计划。
