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Sphincter-preserving surgery for low-middle rectal cancer: Can we predict feasibility with high-resolution magnetic resonance imaging?

ABSTRACT: The study proposed to evaluate the feasibility of predicting sphincter-sparing surgery (SSS) preoperatively in low-middle rectal cancer by using magnetic resonance (MR).The study included both retrospective and prospective design. In the retrospective design, the distance from lower edge of tumor to upper margin of the internal sphincter (Dis1) and distance to anal verge (Dis2) were measured on MR, the distance to anal verge recorded by colonoscopy (Dis3) and digital rectal examination (Dis4) were also obtained. ROC analysis was conducted and cut-off value was determined with overall and stratified analysis. The prospective part was designed to validate the predictive capability of the optimal distance.The retrospective design included 278 patients with middle or lower rectal adenocarcinoma, the prospective design included 106 patients with neoadjuvant therapies. The primary outcome was the actual surgical method and pathological distal resection margin. Dis1 obtained from MRI presented better performance than other distances in determining the surgical approach, with AUC of 0.997 (95% CI, 0.934-1.000). Dis1 was selected as the optimal distance and a cut-off value of 2?cm was determined. Dis1 and the cut-off value were also validated in the prospective sample, with AUC of 0.996 (95% CI, 0.989-1.000) and an overall accuracy of 99.1%.MR-based distance from lower edge of tumor to upper margin of the internal sphincter could be used to help the surgeons to predict the feasibility of SSS preoperatively.

SUBMITTER: Zhu HB

PROVIDER: S-EPMC5521890 | biostudies-other | 2017 Jul

REPOSITORIES: biostudies-other

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Sphincter-preserving surgery for low-middle rectal cancer: Can we predict feasibility with high-resolution magnetic resonance imaging?

Zhu Hai-Bin HB Wang Lin L Li Zi-Yu ZY Li Xiao-Ting XT Zhang Xiao-Yan XY Sun Ying-Shi YS

Medicine 20170701 29

The study proposed to evaluate the feasibility of predicting sphincter-sparing surgery (SSS) preoperatively in low-middle rectal cancer by using magnetic resonance (MR).The study included both retrospective and prospective design. In the retrospective design, the distance from lower edge of tumor to upper margin of the internal sphincter (Dis1) and distance to anal verge (Dis2) were measured on MR, the distance to anal verge recorded by colonoscopy (Dis3) and digital rectal examination (Dis4) we ...[more]

PMID: 28723750

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Project description:BACKGROUND:Although controversial, there are data suggesting that clinical parameters can predict the probability of sphincter preserving procedures in rectal cancer. The purpose of this study was to investigate the association between clinical parameters and the sphincter-preserving surgery rate in patients who had undergone neoadjuvant combination therapy for advanced low rectal cancer. METHODS:In this single center study, the charts of 540 patients with locally advanced rectal cancer who had been treated with induction chemotherapy-and/or neoadjuvant concomitant radiochemotherapy (nRCT) over an 11-year period were reviewed in order to identify patients with rectal cancer ?6?cm from the anal verge, who had received the prescribed nRCT only. Univariate and multivariate analyses were used to identify pretreatment patient- and tumor associated parameters correlating with sphincter preservation. Survival rates were calculated using Kaplan-Meier analyses. RESULTS:Two hundred eighty of the 540 patients met the selection criteria. Of the 280 patients included in the study, 158 (56.4%) underwent sphincter-preserving surgery. One hundred sixty-four of 280 patients (58.6%) had a downsizing of the primary tumor (ypT?<?cT) and 39 (23.8%) of these showed a complete histopathological response (ypT0 ypN0). In univariate analysis, age prior to treatment, Karnofsky performance status, clinical T-size, relative lymphocyte value, CRP value, and interval between nRCT and surgery, were significantly associated with sphincter-preserving surgery. In multivariate analysis, age (hazard ratio (HR)?=?1.05, CI95%: 1.02-1.09, p?=?0.003), relative lymphocyte value (HR?=?0.94, CI95%: 0.89-0.99, p?=?0.029), and interval between nRCT and surgery (HR?=?2.39, CI95%: 1.17-4.88, p?=?0.016) remained as independent predictive parameters. CONCLUSIONS:These clinical parameters can be considered in the prognostication of sphincter-preserving surgery in case of low rectal adenocarcinoma. More future research is required in this area.

Project description:Background:Defunctioning stoma is widely used to reduce anastomotic complications in rectal cancer surgery. However, the complications of stoma and stoma reversal surgery should not be underestimated. Furthermore, in some patients, stoma reversal failed. Here, we investigated the complications of defunctioning stoma surgery and subsequent reversal surgery and identify risk factors associated with the failure of getting stoma reversed. Methods:In total, 154 patients who simultaneously underwent low anterior resection and defunctioning stoma were reviewed. Patients were divided into two groups according to whether their stoma got reversed or not. The reasons that patients received defunctioning stoma and experienced stoma-related complications and the risk factors for failing to get stoma reversed were analysed. Results:The mean follow-up time was 47.54 (range 4.0-164.0) months. During follow-up, 19.5% of the patients suffered stoma-related long-term complications. Only 79 (51.3%) patients had their stomas reversed. The morbidity of complications after reversal surgery was 45.6%, and these mainly consisted of incision-related complications. Multivariate analyses showed that pre-treatment comorbidity (HR = 3.17, 95% CI 1.27-7.96, P = 0.014), postoperative TNM stage (HR = 2.55, 95% CI 1.05-6.18, P = 0.038), neoadjuvant therapy (HR = 2.75, 95% CI 1.07-7.05, P = 0.036), anastomosis-related complications (HR = 4.52, 95% CI 1.81-11.29, P = 0.001), and disease recurrence (HR = 24.83, 95% CI 2.90-213.06, P = 0.003) were significant independent risk factors for a defunctioning stoma to be permanent. Conclusions:Defunctioning stoma is an effective method to reduce symptomatic anastomotic leakage, but the stoma itself and its reversal procedure are associated with high morbidity of complications, and many defunctioning stomas eventually become permanent. Therefore, surgeons should carefully assess preoperatively and perform defunctioning stomas in very high risk patients. In addition, doctors should perform stoma reversal surgery more actively to prevent temporary stomas from becoming permanent.

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Sphincter-preserving surgery for low-middle rectal cancer: Can we predict feasibility with high-resolution magnetic resonance imaging?

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Sphincter-preserving surgery for low-middle rectal cancer: Can we predict feasibility with high-resolution magnetic resonance imaging?

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