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S5.03 The residual tumour status must be recorded according to the AJCC Cancer Staging Manual (7th Edition)9 CS5.03a The R codes are as follows. (Used with the permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer Science and Business Media LLC, www.springerlink.com.) • • • R0: Complete resection, margins histologically negative, no residual tumour left after resection (primary tumour, regional nodes) R1: Incomplete resection, margins histologically involved, microscopic tumour remains after resection of gross disease (primary tumour, regional nodes) R2: Incomplete resection, margins macroscopically involved or gross disease remains after subtotal resection (eg primary tumour, regional nodes, or liver metastasis). CS5.03b • CS5.03c The resection status rule also applies to lymph nodes. If a positive lymph node is left behind it is classified as R2. CS5.03d • CS5.03e Peritoneal involvement alone is not a reason to categorise the tumour as incompletely excised. Residual tumour classification (R status) is not limited to the primary tumour. The R classification not only considers locoregional residual tumour, but also distant residual tumour in the form of unresected or incompletely resected metastases (R2)94 For example, a metastasis in the liver from a primary colorectal carcinoma would be M1 and R0 if the metastasis was solitary and resected with tumour-free margins. This case would be M1 and R2 if the metastasis was not resected. Tumour cells that are confined to the lumen of blood vessels or lymphatics at the resection margin are classified as R0.94