78 year lady underwent upfront lap sigmoid colectomy for a bulky tumor. Distal resection margin below promontory with distal resection margin 6 cm. post operative course uneventful. Final histology t3n1 with 2/30 nodes positive. However distal resection margin showed acellular mucin. Would she require resurgent for this or close observation with adjuvant chemotherapy?
Dear Avanish,
I assume, this was a mucinous carcinoma? In that case, the presence of acellular mucin at the resection margin would probably still qualify as R0.
Regardless, as far as I know, pT3N1 is an indication for adjuvant chemotherapy anyway.
Regards
Gerald
I agree with Gerald.
The presence of acellular mucin has no prognostic significance.
pT3N1 Is Duke C or Stage IIIB following the UICC classification. Your Patient is a candidate for adjuvant chemotherapy
I think, mucin itself , even if there is no visible tumor cells, could be taken as a presence of tumor tissue.
Presence of acellular mucin after neoadjuvant therapy has no prognostic significance as therapy itself induces mucinous changes. This has been validated in studies, however, this data is present only for this selective setting of post NACTRT acellular mucin. That data should not be extrapolated to therapy-naive cases.
A n acellular mucin can not be qualified as acellular. The mucin itself is not a natural component of the bowel wall histology. If there is mucin in the bowel wall, it is for sure that there was tumor cells at least once in there. However, going back to Phil Quirke papers, only 80 % of margin positive resections have recurrence. So, if we consider this case as an R1 resection, it doesn't mean that it will recur 100 %. But, don't be surprised to have a recurrence after a year or two.
Patient recieved adjuvant chemotherapy and is on surveillance more than 2 years, disease free. No rerescection required
she underwent flexible sigmoidoscopy every 6 months
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