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Surgery Today
Published in: Surgery Today 12/2018

01-12-2018 | Original Article

Magnetic resonance-based pelvimetry and tumor volumetry can predict surgical difficulty and oncologic outcome in locally advanced mid–low rectal cancer

Authors: Gulsen Atasoy, Naciye Cigdem Arslan, Funda Dinc Elibol, Ozgul Sagol, Funda Obuz, Selman Sokmen

Published in: Surgery Today | Issue 12/2018

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Abstract

Purpose

To investigate the impact of the pelvic dimensions and tumor volume on surgery in locally advanced rectal cancer.

Methods

Patients who underwent open surgery after neoadjuvant long-course chemoradiation for primary rectal cancer were included. The predictive value of magnetic resonance-based pelvic measurements and tumor volume on the surgical difficulty and oncologic outcome were analyzed.

Results

125 patients were included. The independent risk factors related to the circumferential resection margin status were the pT stage [odds ratio (OR) 3.64, confidence interval (CI) 1.409–7.327] and tumor volume after neoadjuvant chemoradiotherapy (OR 1.59, CI 1.018–2.767). The operative time (p = 0.014, OR 1.453) and pelvic depth (p = 0.023, OR 1.116) were independent predictive factors for anastomotic leak. The median follow-up was 72 (2–113) months. Local recurrence was seen in 17 (14.1%) patients. Anastomotic leak (OR 1.799, CI 0.978–3.277), the circumferential resection margin status (OR 3.217, CI 1.262–7.870) and the relative tumor volume rate (OR 1.260, CI 1.004–1.912) were independent prognosticators of local recurrence. The 5-year overall survival was 66.7%. The circumferential resection margin status (hazard ratio: 4.739, CI 2.276–9.317), pN stage (OR 3.267, CI 1.195–8.930) and relative tumor volume rate (OR 2.628, CI 1.042–6.631) were independent prognostic factors for the overall survival.

Conclusions

Relative dimensions of the tumor in the pelvis influence the local recurrence and overall survival rates. Magnetic resonance-based measurements can predict the difficulty of surgery and allow surgeons to consider the appropriate surgical approach.
Literature
1.
Kornprat P, Pollheimer MJ, Lindtner RA, Schlemmer A, Rehak P, Langner C. Value of tumor size as a prognostic variable in colorectal cancer: a critical reappraisal. Am J Clin Oncol. 2011;34(1):43–9.CrossRef
2.
Crozier JE, McMillan DC, McArdle CS, Angerson WJ, Anderson JH, Horgan PG, et al. Tumor size is associated with the systemic inflammatory response but not survival in patients with primary operable colorectal cancer. J Gastroenterol Hepatol. 2007;22(12):2288–91.CrossRef
3.
Trakarnsanga A, Gonen M, Shia J, Goodman KA, Nash GM, Temple LK, et al. What is the significance of the circumferential margin in locally advanced rectal cancer after neoadjuvant chemoradiotherapy? Ann Surg Oncol. 2013;20(4):1179–84.CrossRef
4.
Baik SH, Kim NK, Lee KY, Sohn SK, Cho CH, et al. Factors influencing pathologic results after total mesorectal excision for rectal cancer: analysis of consecutive 100 cases. Ann Surg Oncol. 2008;15(3):721–8.CrossRef
5.
Quirke P, Durdey P, Dixon M, Williams N. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Lancet. 1986;2(8514):996–9.CrossRef
6.
Leonard D, Penninckx F, Fieuws S, Jouret-Mourin A, Sempoux C, Jehaes C, et al. Factors predicting the quality of total mesorectal excision for rectal cancer. Ann Surg. 2010;252(6):982–8.CrossRef
7.
8.
Wibe A, Rendedal P. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg. 2002;98(8):327–34.CrossRef
9.
Curvo-Semedo L, Lambregts DM, Maas M, Thywissen T, Mehsen RT, Lammering G, et al. Rectal cancer: assessment of complete response to preoperative combined radiation therapy with chemotherapy–conventional MR volumetry versus diffusion-weighted MR imaging. Radiology. 2011;260(3):734–43.CrossRef
10.
Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147(3):339–51.CrossRef
11.
Salerno G, Daniels IR, Brown G, Heald RJ, Moran BJ. Magnetic resonance imaging pelvimetry in 186 patients with rectal cancer confirms an overlap in pelvic size between males and females. Colorectal Dis. 2006;8(9):772–6.CrossRef
12.
Boyle KM, Petty D, Chalmers G, Quirke P, Cairns A, Finan PJ, et al. MRI assessment of the bony pelvis may help predict resectability of rectal cancer. Colorectal Dis. 2005;7(3):232–40.CrossRef
13.
Kim CW, Baek SJ, Hur H, Min BS, Baik SH, Kim NK. Anastomotic leakage after low anterior resection for rectal cancer is different between minimally invasive surgery and open surgery. Ann Surg. 2006;263(1):130–7.CrossRef
14.
15.
Bogach J, Tsai S, Zbuk K, Wong R, Grubac V, Coates A, et al. Quality of preoperative pelvic computed tomography (CT) and magnetic resonance imaging (MRI) for rectal cancer in a region in Ontario: a retrospective population-based study. J Surg Oncol. 2018;117(5):1038–42.CrossRef
16.
Can CT. Replace MRI in preoperative assessment of the circumferential resection margin in rectal cancer? Dis Colon Rectum. 2010;53(3) 308–14.CrossRef
17.
Nasseri Y, Langenfeld SJ. Imaging for colorectal cancer. Surg Clin North Am. 2017;97(3):503–13.CrossRef
18.
Akiyoshi T, Watanabe T, Ueno M. Pelvic dimensions as a predictor of difficulty in laparoscopic surgery for rectal cancer. Surg Endosc. 2011;25(9):3122–3.CrossRef
19.
Killeen T, Banerjee S, Vijay V, Al-Dabbagh Z, Francis D, Warren S. Pelvic dimensions as a predictor of difficulty in laparoscopic surgery for rectal cancer. Surg Endosc. 2012;26(1):277.CrossRef
20.
Ogiso S, Yamaguchi T, Hata H, Fukuda M, Ikai I, Yamato T. Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: “narrow pelvis” is not a contraindication. Surg Endosc. 2011;25(6):1907–12.CrossRef
21.
Bertani E, Chiappa A, Della Vigna P, Radice D, Papis D, Cossu L, Biffi R, et al. The Impact of pelvimetry on anastomotic leakage in a consecutive series of open, laparoscopic and robotic low anterior resections with total mesorectal excision for rectal cancer. Hepatogastroenterology. 2014;61(134):1574–81.PubMed
22.
Yeo SG, Kim DY, Kim TH, Jung KH, Hong YS, Chang HJ, Park JW, et al. Tumor volume reduction rate measured by magnetic resonance volumetry correlated with pathologic tumor response of preoperative chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys. 2010;78(1):164–71.CrossRef
23.
Young HK, Dae YK, Tae HK, Jung KH, Chang HJ, Jeong SY, et al. Usefulness of magnetic resonance volumetric evaluation in predicting response to preoperative concurrent chemoradiotherapy in patients with resectable rectal cancer. Int J Radiat Oncol Biol Phys. 2005;62(3):761–8.CrossRef
24.
Lambrecht M, Vandecaveye V, De Keyzer F, Roels S, Penninckx F, Van Cutsem E, et al. Value of diffusion-weighted magnetic resonance imaging for prediction and early assessment of response to neoadjuvant radiochemotherapy in rectal cancer: preliminary results. Int J Radiat Oncol Biol Phys. 2012;82(2):863–70.CrossRef
25.
Lee Y-C, Hsieh C-C, Chuang J-P. Prognostic significance of partial tumor regression after preoperative chemoradiotherapy for rectal cancer: a meta-analysis. Dis Colon Rectum. 2013;56(9):1093–101.CrossRef
26.
Nougaret S, Rouanet P, Molinari N, Pierredon MA, Bibeau F, Azria D, et al. MR volumetric measurement of low rectal cancer helps predict tumor response and outcome after combined chemotherapy and radiation therapy. Radiology. 2012;263(2):409–18.CrossRef
27.
Poritz LS, Sehgal R, Hartnett K, Berg A, Koltun WA. Tumor volume and percent positive lymph nodes as a predictor of 5-year survival in colorectal cancer. Surgery. 2011;150(4):649–55.CrossRef
28.
Ferko A, Malý O, Örhalmi J, Dolejš J. CT/MRI pelvimetry as a useful tool when selecting patients with rectal cancer for transanal total mesorectal excision. Surg Endosc. 2016;30(3):1164–71.CrossRef
29.
Kim JY, Kim YW, Kim NK, Hur H, Lee K, Min BS, et al. Pelvic anatomy as a factor in laparoscopic rectal surgery: a prospective study. Surg Laparosc Endosc Percutan Tech. 2011;21(5):334–9.CrossRef
30.
Baek SJ, Kim CH, Cho MS, Bae SU, Hur H, Min BS, et al. Robotic surgery for rectal cancer can overcome difficulties associated with pelvic anatomy. Surg Endosc. 2015;29(6):1419–24.CrossRef
31.
Yang Y, Wang F, Zhang P, Shi C, Zou Y, Qin H. Robot-assisted versus conventional laparoscopic surgery for colorectal disease, focusing on rectal cancer: a meta-analysis. Ann Surg Oncol. 2012;19(12):3727–36.CrossRef
32.
33.
Xu W, Xu Z, Cheng H, Ying J, Cheng F, Xu W, et al. Comparison of short-term clinical outcomes between transanal and laparoscopic total mesorectal excision for the treatment of mid and low rectal cancer: a meta-analysis. 2016;42(12):1841–50.
Metadata
Title
Magnetic resonance-based pelvimetry and tumor volumetry can predict surgical difficulty and oncologic outcome in locally advanced mid–low rectal cancer
Authors
Gulsen Atasoy
Naciye Cigdem Arslan
Funda Dinc Elibol
Ozgul Sagol
Funda Obuz
Selman Sokmen
Publication date
01-12-2018
Publisher
Springer Singapore
Published in
Surgery Today / Issue 12/2018
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-018-1690-3

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