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01-07-2015 | Colorectal Cancer

Effects of Preoperative Chemoradiotherapy on the Likelihood of Sphincter Preservation Surgery in Locally Advanced Distal Rectal Cancer: A Longitudinal Study Based on Pelvic Magnetic Resonance Imaging

Authors: Myong Hoon Ihn, MD, Young Hoon Kim, MD, Duck-Woo Kim, MD, Heung-Kwon Oh, MD, Soo Young Lee, MD, Jin Taek Park, MD, Il Tae Son, MD, Ji Hoon Park, MD, Yoon Jin Lee, MD, Jin Won Kim, MD, Keun-Wook Lee, MD, Jee Hyun Kim, MD, Eun Shin, MD, Hye Seung Lee, MD, Soyeon Ahn, PhD, Sung-Bum Kang, MD

Published in: Annals of Surgical Oncology | Issue 7/2015

Abstract

Background

It is unclear whether preoperative chemoradiotherapy (pCRT) increases the rate of sphincter-preserving surgery (SPS), avoiding abdominoperineal resection (APR), for the treatment of distal rectal cancer. We examined whether pCRT increases the likelihood of SPS based on changes in tumor height using pelvic magnetic resonance imaging (MRI).

Methods

Between January 2009 and December 2013, 105 patients underwent long-course pCRT for locally advanced distal rectal cancer (≤5 cm from the anal verge) and were included in this study. The surgical procedures were analyzed in terms of radiologic findings, including the distance from the inferior margin of tumor to the superior margin of the anorectal ring (tumor height) measured by pelvic MRI before and after pCRT.

Results

Eighty-six (81.9 %) patients underwent SPS. Overall clinical downstaging occurred in 48 (45.7 %) patients. Tumor height increased significantly after pCRT (from 15.0 ± 15.3 to 18.1 ± 16.9 mm, change 3.1 ± 9.7 mm, p = 0.01). The mean change in tumor height was not significantly different between patients who underwent SPS or APR (mean change 3.3 ± 9.6 vs. 2.3 ± 10.5 mm, p = 0.68). The mean change was significantly greater in the double-stapled anastomosis group than in the handsewn anastomosis group (mean change 5.6 ± 9.9 vs. −0.6 ± 8.6 mm, p = 0.02).

Conclusions

This was the first MRI-based longitudinal study to show that pCRT does not appear to increase the likelihood of SPS in locally advanced distal rectal cancer, although it could improve the potential of double-stapled anastomoses.

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Title: Effects of Preoperative Chemoradiotherapy on the Likelihood of Sphincter Preservation Surgery in Locally Advanced Distal Rectal Cancer: A Longitudinal Study Based on Pelvic Magnetic Resonance Imaging
Authors: Myong Hoon Ihn, MD
Young Hoon Kim, MD
Duck-Woo Kim, MD
Heung-Kwon Oh, MD
Soo Young Lee, MD
Jin Taek Park, MD
Il Tae Son, MD
Ji Hoon Park, MD
Yoon Jin Lee, MD
Jin Won Kim, MD
Keun-Wook Lee, MD
Jee Hyun Kim, MD
Eun Shin, MD
Hye Seung Lee, MD
Soyeon Ahn, PhD
Sung-Bum Kang, MD
Publication date: 01-07-2015
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 7/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-4286-1

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Effects of Preoperative Chemoradiotherapy on the Likelihood of Sphincter Preservation Surgery in Locally Advanced Distal Rectal Cancer: A Longitudinal Study Based on Pelvic Magnetic Resonance Imaging

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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