Circumferential Resection Margins As Clinicopathological Predictor for Local Recurrence of Rectal Cancer: A Systematic Review and Meta-Analysis

OBJECTIVES: To identify and quantify the association between the local recurrence of rectal cancer and circumferential resection margin following curative resection by systematically reviewing the current literature.

METHODS: Relevant studies were retrieved by searching PubMed, Science Direct and Google Scholar advanced databases. Data extracted include bibliographic data, study characteristics, patient characteristics, and CRM as a risk factor for the recurrence of rectal cancer.

RESULTS: A total of thirteen studies were included in this meta-analysis reporting a pooled sample size of 5809 patients who were having CRM greater than 2mm (negative) and out of the 1089 patients developed local recurrence. While 1050 patients had CRM less than 2mm (positive) and out of them 290 patients developed local recurrence. We performed a meta-analysis to check the relative risk between positive and negative CRM. A statistical significance was observed between the local recurrence and positive CRM showing circumferential resection margin <2mm (2.13[1.99,2.43]) p<0.001 with a heterogeneity of 18%.

CONCLUSIONS: Positive circumferential resection margin has strong association with the recurrence of rectal cancer. Patients with positive CRM developed more recurrences as compared to patients having negative CRM.