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Depth and lateral spread of microscopic residual rectal cancer after neoadjuvant chemoradiation: implications for treatment decisions
Author(s) -
Smith F. M.,
Wiland H.,
Mace A.,
Pai R. K.,
Kalady M. F.
Publication year - 2014
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12608
Subject(s) - medicine , colorectal cancer , pathological , incidence (geometry) , intestinal mucosa , pathology , cancer , geometry , mathematics
Aim The aim of this study was to determine the distribution of residual tumour within the bowel wall in relation to residual mucosal abnormalities ( RMA s) and surrounding normal mucosa in patients with rectal cancer who underwent neoadjuvant chemoradiation followed by curative surgery. Method Archived pathological slides from a cohort of 60 patients with residual tumour were retrieved. The incidence, distance and depth of tumour spread (yp T ) under RMA s and adjacent normal mucosa were reviewed and recorded. Results Histological sections containing both RMA and adjacent normal mucosa were available for 45 of 60 patients with yp T 1 ( n = 6), yp T 2 ( n = 18) and yp T 3 ( n = 21) disease. The maximal depth of invasion, as measured by yp T stage, was found underneath the RMA in 44 of 45 (98%) patients. Microscopic tumour spread lateral to the RMA and under adjacent normal mucosa was found in 32 of 45 (71%) patients. The median and maximum distances of lateral spread for yp T 1 tumours were 0 and 4 mm; for yp T 2 were 2.5 and 9 mm; and for yp T 3 were 4 and 9 mm respectively. Conclusion Lateral tumour spread under normal mucosa adjacent to RMA s is a common finding and extended up to 9 mm in this study. The epicentre for maximum depth of invasion was directly underneath the RMA s in nearly all cases. These data have clinical and technical implications if local excision is to be considered.