This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Magnetic resonance imaging‐detected lymph nodes close to the mesorectal fascia are rarely a cause of margin involvement after total mesorectal excision. BJS 2010; 97: 1431-1436.

Published: 5th July 2010

Authors: O. C. Shihab, P. Quirke, R. J. Heald, B. J. Moran, G. Brown

Background

In rectal cancer the management of suspicious magnetic resonance imaging (MRI)‐detected lymph nodes lying close to the mesorectal fascia poses an ongoing dilemma. Key decisions in treatment planning are commonly based on the prediction of margin status. However, it is unclear whether a lymph node that appears to contain tumour close to the mesorectal fascia will result in a positive margin.

Method

Some 396 patients with rectal cancer were included. MRI assessment of mesorectal nodes, the pathologically involved circumferential resection margin (CRM) rate and causes of margin involvement were analysed to establish the clinical significance of MRI‐detected suspicious lymph nodes at the resection margin.

Results

Fifty (12·6 per cent) of 396 patients had a positive CRM on histopathological analysis, five (10 per cent) solely due to an involved lymph node. Four of the five malignant nodes were not predicted on MRI. Thirty‐one of the 396 MRI studies had suspicious nodes 1 mm or less from the CRM. None of these patients had a positive CRM owing to nodal involvement.

Conclusion

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