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The retroperitoneal surface in distal caecal and proximal ascending colon carcinoma: the Cinderella surgical margin?

¹ Department of Cellular Pathology, Southampton University Hospitals NHS Trust, Southampton S016 6YD UK
² Department of Cellular Pathology, John Radcliffe Hospital, Oxford OX3 9DU, UK

Correspondence to:
Dr A C Bateman
Department of Histopathology, Mailpoint 2, Level E, South Block, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; adrian.bateman{at}suht.swest.nhs.uk
ABSTRACT
Background: Mesorectal margin tumour involvement is a predictor of local recurrence in rectal carcinoma and an indication for postoperative radiotherapy in suitable patients. However, the prevalence of non-peritonealised surgical margin involvement in ascending colon carcinoma is unknown.

Aims: To test the hypothesis that retroperitoneal surgical margin (RSM) tumour involvement occurs in distal caecal and proximal ascending colon carcinoma.

Methods/Results: One hundred right hemicolectomy specimens, removed for adenocarcinoma of the caecum or proximal ascending colon, were studied. During routine specimen dissection, at least one additional tissue block was taken to include the tumour and the RSM. The tumour distance from the RSM was recorded. RSM tumour involvement was present in seven cases (7%). Direct (non-nodal) RSM tumour involvement (five cases) only occurred in posterior or circumferential tumours.

Conclusions: RSM tumour involvement occurs within a considerable number of distal caecal and proximal ascending colon carcinomas. The rate of RSM tumour involvement identified here is similar to a previously published local recurrence rate of 10% in caecal carcinoma, suggesting that RSM tumour involvement may be a predictor of recurrence in these tumours. Therefore, patients with distal caecal or proximal ascending colon carcinoma and RSM tumour involvement may benefit from postoperative radiotherapy.

Abbreviations: RSM, retroperitoneal surgical margin

Keywords: adenocarcinoma; ascending colon; caecum; retroperitoneal surface; surgical margin

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