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Margins in Rectal Cancer Surgery

Key findings

In 2017, the positive margin rate for rectal cancer surgery was 7%. This rate has remained steady for the last 5 years.

Why is this important to Ontarians?

  • Surgery is the primary treatment for patients with rectal cancer; other forms of treatment, such as radiation or chemotherapy, are often used to complement surgical treatment.
  • The aim of rectal cancer surgery is to remove the entire tumour and some normal tissue surrounding it (“the margin”). A margin is the area of tissue at the edge of the specimen. A positive margin means cancer cells may have been left behind.
  • The CCO guideline, Optimization of Surgical and Pathological Quality Performance in Radical Surgery for Colon and Rectal Cancer: Margins and Lymph Nodes recommends that, for rectal cancer patients, negative margins are the goal of rectal resection.
  • Research shows that negative margins have decreased local recurrence rates and increased survival in patients compared with positive margins.[1]

See Margins in Rectal Cancer Surgery Methodology for technical information.

Report date: March 2019
Data sources: Pathology Datamart-Enterprise Data Warehouse
Prepared by: Analytics and Informatics, Cancer Care Ontario

Data Table 1: Percentage of rectal cancer surgery resection reports with involved (positive) circumferential radial margins, 2013 to 2017
Calendar Year Percentage (%)
2013 7.7
2014 7.4
2015 7.5
2016 8.7
2017 7.3

Report date: March 2019
Data sources: Pathology Datamart-Enterprise Data Warehouse
Prepared by: Analytics and Informatics, Cancer Care Ontario

Results

  • In Ontario, 7% of rectal cancer resection reports show positive margins.
  • The rectal cancer resection report rate has ranged from 7% to 9% since 2013.

Comparisons

Getting comparable data and measures from multiple jurisdictions is a challenge. Be aware of the different data definitions, methodologies and years used in indicators measured outside of Ontario. Jurisdictional comparison is still useful to provide a rough indication of how well Ontario is doing relative to other provinces and countries.

  • The 2015/16 in Scotland, 6% of rectal cancer resection reports show positive margins. This represents 30 patients.[2]
  • The data from Scotland excludes transanal resections, which are included in Ontario’s data though they represent a small proportion of the patients (0% to 1%; data not shown).

Highlights

  • This is the expected performance for this indicator and suggests high quality surgical care in Ontario.

For more information

For more information about the Surgical Oncology Program, visit the Surgical Oncology Program on Cancer Care Ontario’s website.

Visit Quality Improvement Resources for Surgical Oncology for resources to help physicians learn about, discuss and provide feedback on quality issues in cancer.

References

  1. Smith AJ, Driman DK, Spithoff K, McLeod R, Hunter A, Rumble RB, Langer B and Expert Panel on Colon and Rectal Cancer Surgery and Pathology. Optimization of Surgical and Pathological Quality Performance in Radical Surgery for Colon and Rectal Cancer: Margins and Lymph Nodes Guideline Recommendations. 2008.
  2. National Services Scotland. Colorectal Cancer Quality Performance Indicators [Internet]. (2017) [cited 2019 April 12]. Available from https://www.isdscotland.org/Health-Topics/Quality-Indicators/Publications/2017-06-27/2017-06-27-Colorectal-QPI-Report.pdf