The significance of involvement of a free serosal surface for recurrence and survival following resection of clinicopathological stage B and C rectal cancer

Abstract

This study has confirmed that direct tumour spread to a free serosal surface independently predicts pelvic recurrence and diminished survival after resection of clinicopathological stage B and C rectal cancer. This feature should always be sought by the pathologist and reported when present, and noted by the surgeon and oncologist. Serosal involvement should be evaluated further for its utility in selecting patients for adjuvant therapy.

Correlations between Integrin ανβ6 Expression and Clinico-Pathological Features in Stage B and Stage C Rectal Cancer

“…Blocks were taken to demonstrate maximum direct tumour penetration of the bowel wall. Additional blocks were taken specifically to demonstrate the relationship between tumour and any adherent structure or tissue [21] as well as lines of resection and the free serosal surface [22]. Tumour level in the rectum was measured from the anal verge.…”

Tumor Budding and Survival After Potentially Curative Resection of Node-Positive Colon Cancer

“…Additional blocks were taken specifically to demonstrate the relationship between the tumor and any adherent structure or tissue, 22 as well as lines of resection and the free serosal surface. 23 Venous invasion referred to involvement of thin-walled or thick-walled veins, either within or beyond the bowel wall. When doubt existed as to whether a structure involved was a vein, a negative finding was recorded.…”

TNM staging system of colorectal carcinoma: surgical pathology of the seventh edition

“…26,27 This classification was based on a study showing the adverse prognostic inference for local peritoneal involvement in curative resection of colon cancer according to different patterns of tumour/mesothelium interface, 29 and on the Erlangen Registry of Colorectal Carcinoma data showing that the frequency of distant metastasis is higher in cases with perforation of the visceral peritoneum compared to cases with direct invasion of adjacent organs or structures, and that the median survival time after curative surgery is shorter for patients with pT4b tumours compared to those with pT4a tumours. 21,27 The different behaviour between pT4a and pT4b tumours is most likely to be due to the fact that tumour cells present on the free surface of the peritoneum would have a greater opportunity to seed into the peritoneal cavity leading to carcinomatosis (Figures 2 and 3aeb), whereas tumour cells invading through a serosal surface which had previously become tightly adherent to adjacent structures (or organs) would remain confined due to florid inflammation and fibrosis 30 (Figures 4aec and 5). In the latter case, the involved visceral peritoneum would remain covered by the adhesion to adjacent structures or organs, making seeding into the peritoneal cavity more difficult; in these cases, "en bloc" resections may be performed safely and effectively curative.…”