Pathologists’ Role in the Evaluation of the Prognostic Implications of Circumferential Resection Margin in Resected Rectal Carcinoma

Colorectal cancer is one of the most common malignancies in Sri Lanka as well as in other parts of the world and has a high incidence of cancer related deaths. Recent advances have been made with regard to the biological understanding of this disease and its treatment. Furthermore, new surgical, chemotherapeutic and radiotherapeutic strategies have been developed over the last decade in view of improving the quality of care. The worldwide introduction of total mesorectal excision (TME) in combination with the increasing use of neoadjuvant therapy has significantly improved the overall outcome. An important prognostic factor in rectal cancer is the status of the circumferential resection margin (CRM). The involvement of this margin has been associated with a poor prognosis. Pathologists play a vital role by providing important information for the clinical management of the patient and for the evaluation of health care as a whole. For the patient it confirms the diagnosis and describes the variables that will affect the prognosis, all of which will be relevant for the future management. For health care evaluation, pathology reports provide information for cancer registration and audit related to diagnostic and surgical procedures. Accurate evaluation of CRM in rectal carcinoma is important to determine the risk of local recurrence, which might subsequently be prevented by additional therapy. An increased risk was seen when the distance to CRM was < 2 mm.