Histopathologic support of the 2 cm distal resection margin for rectal carcinoma

ABSTRACT

Recent evidence has shown that a five-centimeter distal margin is not required for cancers of the rectum. These findings proved significant in that selected patients with low rectal lesions can be offered curative operations that can preserve normal sphincter function, an intact route of defecation, and have a better quality of life. From August 2000 to July 2001, we began our series of examining specimens after rectal resection to determine the negative distal margin. The specimens for pathologic examination were cut at 0.5 cm intervals up to 2.0 cm from the raised distal edge of the tumor. The objective of this paper is to determine the distance of intramural tumor spread of rectal cancer from the macroscopic tumor edge. During the one-year period, a total of 11 specimens from rectal cancer patients were examined, ages of the patients ranged from 29 to 77 years. Eighty-two percent of patients had locally advanced (T3 and T4) lesions. Lymph node involvement was seen in 72 percent. Analysis of distal margins showed the following five of 11 (45 percent) were positive for malignant cells at 0.5 cm from the tumor edge, four of 11 (36 percent) positive at 1.0 cm, one of 11 (nine percent) positive at 1.5 cm, and no malignant cells were seen at 2.0 cm distal margin. Our early results support the adequacy of a 2 cm distal resection margin for rectal cancer surgery. (Author)