For patients with rectal cancer, the strongest predictor of local recurrence is the circumferential resection margin (CRM) after surgery, with negative CRMs being the goal. Current guidelines recommend preoperative chemoradiotherapy (CRT) before surgery, as this has been shown to decrease the rate of local recurrence. CRT, however, is associated with other long-term adverse outcomes, including bowel and sexual dysfunction. With improvements in modern surgical techniques, magnetic resonance imaging (MRI) has been proposed as a tool to be used in identifying patients with “good prognosis” tumors that may be able to avoid CRT and its associated side effects. In this cohort study, 82 patients with MRI-predicted “good prognosis” rectal cancers who did not undergo CRT were followed up for CRM status to evaluate the use of MRI criteria in identifying patients with “good prognosis” rectal tumors for primary surgery. Investigators found that the mean CRM distance was 12.8 mm (range 0 mm to 70 mm), that 91% of tumors were of stage T2 or greater, and that 59% of patients had stage II or III disease. The rate of positive CRM was 4.9% (95% CI 0.2% to 9.6%), and one patient had a positive distal margin. Results from this study suggest that CRT may not be necessary for all patients and that MRI findings could potentially be used in offering patients with “good prognosis” the option of avoiding CRT. It should be noted, however, that this study did find a rate of positive CRM in the patients studied and that it analyzed positive CRM rate rather than long-term oncologic outcomes.
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