Assessment of Factors that Predict a Positive Circumferential Resection Margin (CRM) in Rectal Adenocarcinoma

Geethu Rachel Iype, (2019) Assessment of Factors that Predict a Positive Circumferential Resection Margin (CRM) in Rectal Adenocarcinoma. Masters thesis, Christian Medical College, Vellore.


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AIMS AND OBJECTIVES: AIM OF THE STUDY: The aim of the study is to assess the factors that predict a positive Circumferential Resection Margin in rectal adenocarcinomas. OBJECTIVES: 1. To determine if the T stage of the tumour can predict CRM positivity in adult patients undergoing rectal resection for adenocarcinoma rectum in the Colorectal Surgery Unit in CMC Vellore between 2016 and 2018. 2. To determine if others factors like the distance of the lower margin of the tumour from the anal verge, the position of the tumour as predominantly circumferential, lateral, anterior or posterior, the gender of the patient, the Body Mass Index of the patients, extra mural venous invasion (EMVI), CRM positivity on MRI and the histology of the tumour can predict the CRM positivity in the above mentioned group of patients. METHODS: A prospective observational cohort study, designed to analyse multiple factors that may be contributing to a positive CRM. The factors analysed were the ‘T' stage of the tumour, the circumferential position of the tumour, extra mural venous invasion, CRM positivity on MRI, gender, Body Mass Index, histologic grade of differentiation of the tumour and the distance of the lower margin of tumour from the anal verge. RESULTS AND CONCLUSION: 76 patients who underwent rectal resection were included. Mean age was 49 years with 63% of them being male. 5 Patients (6.6%) had a positive CRM, which was associated with poorly differentiated tumours (p = .006) and higher nodal staging (p = 0.022) All the patients with positive CRM had BMI < 30kg/m2 and had undergone sphincter saving operations. Hence positive CRM had a statistically significant association with tumour differentiation and nodal staging. EMVI, breach of mesorectal fascia on MRI, and anterior position of tumour co-related with poorer outcomes, but were not statistically significant. The results are in keeping with internationally published data and the discrepancies could be attributed to the low numbers.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Positive Circumferential Resection Margin (CRM), Rectal Adenocarcinoma.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 02 Sep 2019 06:33
Last Modified: 02 Sep 2019 06:33

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