1
|
Aas‐Eng MK, Young VS, Dormagen JB, Pripp AH, Hudelist G, Lieng M. Lesion-to-anal-verge distance in rectosigmoid endometriosis on transvaginal sonography vs magnetic resonance imaging: prospective study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:243-250. [PMID: 36178730 PMCID: PMC10107681 DOI: 10.1002/uog.26083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 09/01/2022] [Accepted: 09/09/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To compare transvaginal sonography (TVS) and magnetic resonance imaging (MRI) with intraoperative measurement (IOM) using a rectal probe in the estimation of the location of rectosigmoid endometriotic lesions, i.e. lesion-to-anal-verge distance (LAVD), and to compare two different MRI techniques for measuring LAVD. METHODS This was a prospective single-center observational study that included women undergoing surgery for symptomatic rectosigmoid endometriosis by discoid (DR) or segmental (SR) resection from December 2018 to December 2019. TVS and MRI were performed presurgically for each participant to evaluate LAVD, and the measurements on imaging were compared with IOM using a rectal probe. Clinically acceptable difference and limits of agreement (LoA) between TVS and MRI compared with IOM were set at ± 20 mm. Two different measuring methods for MRI, MRICenter and MRIDirect , were proposed and evaluated, as there is currently no guideline to describe deep endometriosis on MRI. Bland-Altman plots and LoA were used to assess agreement of TVS and both MRI methods with IOM. Systematic and proportional biases were assessed using paired t-test and Bland-Altman plots. RESULTS Seventy-five women were eligible for inclusion. Twenty-eight women were excluded, leaving 47 women for the analysis. Twenty-three DR and 26 SR procedures were performed, with both procedures performed in two women. The Bland-Altman plots showed that there were no systematic differences between TVS or MRICenter when compared with IOM for all included participants. MRIDirect systematically underestimated LAVD for lesions located further from the anal verge. TVS, MRICenter and MRIDirect had LoA outside the preset clinically acceptable difference when compared with IOM. LAVD was within the clinically acceptable difference from IOM of ± 20 mm in 70% (33/47) of women on TVS, 72% (34/47) of women on MRICenter and 47% (22/47) of women on MRIDirect . CONCLUSIONS TVS should be the preferred method to estimate the location of a rectosigmoid endometriotic lesion, i.e. LAVD, as it is more available, less expensive and has a similar accuracy to that of MRI. Estimating LAVD can be relevant for planning colorectal surgery for rectosigmoid endometriosis. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- M. K. Aas‐Eng
- Department of GynecologyOslo University HospitalOsloNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
| | - V. S. Young
- Department of Radiology and Nuclear MedicineOslo University HospitalOsloNorway
| | - J. B. Dormagen
- Department of Radiology and Nuclear MedicineOslo University HospitalOsloNorway
| | - A. H. Pripp
- Oslo Center for Biostatistics and EpidemiologyOslo University HospitalOsloNorway
| | - G. Hudelist
- Department of Gynecology, Certified Center for Endometriosis and Pelvic PainHospital St John of GodViennaAustria
- Rudolfinerhaus Private ClinicViennaAustria
- Stiftung Endometrioseforschung/Endometriosis Research Group DACH Region, Central Europe
| | - M. Lieng
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
- Division of Obstetrics and GynecologyOslo University HospitalOsloNorway
| |
Collapse
|
2
|
Liu X, Wang Z, Ren H, Wang Z, Li J. Accuracy of magnetic resonance imaging in defining dentate line in anal fistula. BMC Med Imaging 2022; 22:201. [DOI: 10.1186/s12880-022-00927-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Purpose
To retrospectively assess the accuracy of magnetic resonance imaging (MRI) in defining dentate line in anal fistula.
Materials and methods
Seventy patients with anal fistulas were assessed by dynamic contrast-enhanced MRI. The distance from the dentate line to the anal verge for all patients was measured by MRI. To mitigate interference, 35 patients with anal fistulas whose internal openings were located on the dentate line were excluded from this study. Two observers independently judged the positional relationship between the internal opening and the MRI-defined dentate line, and compared with the results observed by surgeon to assess the accuracy.
Results
The distance between the MRI-defined dentate line and the anal verge depended on the location of the internal opening and the morphology of the anal canal mucosa. The distance based on the location the internal opening and the morphology of the anal canal mucosa was 18.2 ± 8.1 mm and 20.0 ± 5.3 mm on oblique coronal T2WI, respectively. Compared with the results observed by the surgeon, the accuracy of evaluating the positional relationship between the internal opening and the dentate line from the morphology of the anal canal mucosa on MRI exceeded 89.9%. Taking 18.2–20.0 mm as the distance between the dentate line and the anal verge on the MRI image, the accuracy of evaluating the relationship between the position of the internal opening and the dentate line was over 85.7%. Considering both the dentate line and the anal canal mucosa, the accuracy of evaluating the relationship between the internal opening and the dentate line was over 91.5%. The results of MRI-defined dentate line were in good agreement with the results of intraoperative surgeon evaluation, and the κ values were 0.70, 0.63, and 0.78, respectively.
Conclusion
MRI has high accuracy in defining the dentate line in anal fistulas.
Collapse
|
3
|
Piozzi GN, Rusli SM, Lee TH, Baek SJ, Kwak JM, Kim J, Kim SH. Robotic approach may be associated with a lower risk of lung metastases compared to laparoscopic approach for mid-low rectal cancer after neoadjuvant chemoradiotherapy: a multivariate analysis on long-term recurrence patterns. Int J Colorectal Dis 2022; 37:2085-2098. [PMID: 36042031 DOI: 10.1007/s00384-022-04249-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Describe differences on recurrence patterns of mid-low rectal cancers treated with neoadjuvant chemoradiotherapy and low anterior resection between laparoscopic and robotic approach. METHODS Patients were identified from a prospectively maintained institutional database between 2006 and 2019. Demographics, clinicopathological features, recurrence, and survival were investigated. Cox regression analysis was performed for risk factor analysis. RESULTS A total of 160 patients (36 laparoscopic and 124 robotic) were included. Systemic recurrence rate was higher in laparoscopic group (27.8 vs 12.1%, p = 0.023). Liver recurrence was similar (11.1 vs 4.0%). Lung recurrence was higher after laparoscopy (19.4 vs 6.5%, p = 0.019). Time to lung recurrence was shorter after laparoscopy (13.0 months, IQR 4.0-20.0) compared to robotic (23.5 months, IQR 17.0-42.7) with no statistical significance. Time to liver recurrence was similar between laparoscopy (19.5 months, IQR 4.7-37.5) and robotic (19.0 months, IQR 10.5-33.0). Median overall survival after lung recurrence was different (p = 0.021) between laparoscopy (19.0 months, IQR 16.0-67.0) and robotic (74.0 months, IQR 50.2-112.2). OS after liver recurrence was similar between groups. Overall survival and lung disease-free survival were different between the two groups (p = 0.032 and p = 0.020), while liver disease-free survival and local recurrence-free survival were not. Laparoscopy (p = 0.030; HR 3.074, 95% CI: 1.112-8.496) was a risk factor for lung disease-free survival on multivariate analysis. CONCLUSION Lung recurrences were less frequent and with better overall survival in the robotic group. Liver recurrences were not influenced by choice of approach. Trials are needed to investigate why the robotic approach affects distant metastasis control.
Collapse
Affiliation(s)
- Guglielmo Niccolò Piozzi
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Siti Mayuha Rusli
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.,Department of Surgery, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Tae-Hoon Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Se-Jin Baek
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jung-Myun Kwak
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jin Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seon Hahn Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
4
|
Evaluation of Nursing Effects of Pelvic Floor Muscle Rehabilitation Exercise on Gastrointestinal Tract Rectal Cancer Patients Receiving Anus-preserving Operation by Intelligent Algorithm-based Magnetic Resonance Imaging. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:1613632. [PMID: 35655733 PMCID: PMC9135567 DOI: 10.1155/2022/1613632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/18/2022] [Indexed: 11/21/2022]
Abstract
Based on magnetic resonance imaging (MRI) technology under artificial intelligence algorithm, the postoperative nursing effects of pelvic floor muscle rehabilitation exercise on gastrointestinal tract rectal cancer (RC) patients were investigated. A total of 88 patients receiving RC anus-preserving surgery in hospital were selected. The included patients were divided randomly into the experimental group (44 cases) and the control group (44 cases). Patients in the control group engaged in Kegel motion, while patients in the experimental group underwent self-designed comprehensive pelvic floor training. Anorectum function rating scale and quality of life questionnaire for colorectal cancer (EORTC QLQ-CR29) were utilized to compare and analyze anus functions and living quality of patients in the two groups. Besides, all patients in two groups received MRI examinations, and images were processed by a convolutional neural network (CNN) algorithm. The results showed that in MRI images, there were significant signal differences between lesion tissues and normal tissues. After being processed by an artificial intelligence algorithm, the definition of MRI images was remarkably enhanced with clearer lesion edges. The quality of images was also significantly improved. Besides, the comparison of anus functions of patients in two groups showed that the differences demonstrated statistical meaning after the intervention (P < 0.05). In conclusion, artificial intelligence algorithm-based MRI and comprehensive pelvic floor muscle exercise showed significant application prospects and values in the recovery of patients' intestinal functions after RC anus-preserving surgery.
Collapse
|
5
|
Nougaret S, Rousset P, Gormly K, Lucidarme O, Brunelle S, Milot L, Salut C, Pilleul F, Arrivé L, Hordonneau C, Baudin G, Soyer P, Brun V, Laurent V, Savoye-Collet C, Petkovska I, Gerard JP, Rullier E, Cotte E, Rouanet P, Beets-Tan RGH, Frulio N, Hoeffel C. Structured and shared MRI staging lexicon and report of rectal cancer: A consensus proposal by the French Radiology Group (GRERCAR) and Surgical Group (GRECCAR) for rectal cancer. Diagn Interv Imaging 2022; 103:127-141. [PMID: 34794932 DOI: 10.1016/j.diii.2021.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To develop French guidelines by experts to standardize data acquisition, image interpretation, and reporting in rectal cancer staging with magnetic resonance imaging (MRI). MATERIALS AND METHODS Evidence-based data and opinions of experts of GRERCAR (Groupe de REcherche en Radiologie sur le CAncer du Rectum [i.e., Rectal Cancer Imaging Research Group]) and GRECCAR (Groupe de REcherche en Chirurgie sur le CAncer du Rectum [i.e., Rectal Cancer Surgery Research Group]) were combined using the RAND-UCLA Appropriateness Method to attain consensus guidelines. Experts scoring of reporting template and protocol for data acquisition were collected; responses were analyzed and classified as "Recommended" versus "Not recommended" (when ≥ 80% consensus among experts) or uncertain (when < 80% consensus among experts). RESULTS Consensus regarding patient preparation, MRI sequences, staging and reporting was attained using the RAND-UCLA Appropriateness Method. A consensus was reached for each reporting template item among the experts. Tailored MRI protocol and standardized report were proposed. CONCLUSION These consensus recommendations should be used as a guide for rectal cancer staging with MRI.
Collapse
Affiliation(s)
- Stephanie Nougaret
- Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, 34295, Montpellier, France.
| | - Pascal Rousset
- Department of Radiology, Lyon 1 Claude-Bernard University, 69495 Pierre-Benite, France
| | - Kirsten Gormly
- Dr Jones & Partners Medical Imaging, Kurralta Park, 5037, Australia; University of Adelaide, North Terrace, Adelaide, South Australia 5000, Australia
| | - Oliver Lucidarme
- Department of Radiology, Pitié-Salpêtrière Hospital, Sorbonne Université, 75013 Paris, France; LIB, INSERM, CNRS, UMR7371-U1146, 75013 Paris, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, 13009 Marseille, France
| | - Laurent Milot
- Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, 69495 Pierre Bénite, France; Lyon 1 Claude Bernard University, 69100 Villeurbanne, France
| | - Cécile Salut
- Department of Radiology, CHU de Bordeaux, Université de Bordeaux, 33000 Bordeaux, France
| | - Franck Pilleul
- Department of Radiology, Centre Léon Bérard, Lyon, France Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621, Lyon, France
| | - Lionel Arrivé
- Department of Radiology, Hopital St Antoine, Paris, France
| | - Constance Hordonneau
- Department of Radiology, CHU Estaing, Université Clermont-Auvergne, 63000 Clermont-Ferrand, France
| | - Guillaume Baudin
- Department of Radiology, Centre Antoine Lacassagne, 06100 Nice, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Vanessa Brun
- Department of Radiology, CHU Hôpital Pontchaillou, 35000 Rennes Cedex, France
| | - Valérie Laurent
- Department of Radiology, Brabois-Nancy University Hospital, Université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | | | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jean Pierre Gerard
- Department of Radiotherapy, Centre Antoine Lacassagne, 06100 Nice, France
| | - Eric Rullier
- Department of Digestive Surgery, Hôpital Haut-Lévèque, Université de Bordeaux, 33600 Pessac, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hospices Civils de Lyon, Lyon Sud University Hospital, 69310 Pierre Bénite, France; Lyon 1 Claude Bernard University, 69100 Villeurbanne, France
| | - Philippe Rouanet
- Department of surgery, Institut Régional du Cancer de Montpellier, Montpellier Cancer Research Institute, INSERM U1194, University of Montpellier, 34295, Montpellier, France
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX, Amsterdam, the Netherlands
| | - Nora Frulio
- Department of Radiology, CHU de Bordeaux, Université de Bordeaux, 33000 Bordeaux, France
| | - Christine Hoeffel
- Department of Radiology, Hôpital Robert Debré & CRESTIC, URCA, 51092 Reims, France
| |
Collapse
|
6
|
Sim KC, Park BJ, Kim MJ, Sung DJ, Han NY, Han YE, Kwak JM, An H. Accuracy of MRI for predicting anterior peritoneal reflection involvement in locally advanced rectal cancer: a comparison with operative findings. Abdom Radiol (NY) 2022; 47:508-516. [PMID: 34842978 DOI: 10.1007/s00261-021-03356-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE To assess the diagnostic accuracy of preoperative rectal MRI for anterior peritoneal reflection (APR) involvement in rectal cancer through comparison with the surgeon's operative findings. METHODS This retrospective study was approved by the institutional review board; informed consent was waived. We enrolled 55 consecutive patients with suspected locally advanced mid-to-upper rectal cancer. All patients underwent rectal MRI using a 3T system. APR involvement in rectal cancer was assessed radiologically using a 5-point scale by two independent board-certified abdominal radiologists. The surgeon's evaluation during surgery was regarded as the gold standard for APR involvement. The accuracy of rectal MRI in predicting APR involvement was obtained. RESULTS Rectal MRI showed good APR identification (rater 1, 92.7%; rater 2, 94.7%). On preoperative rectal MRI, rater 1 diagnosed 19 (34.5%) patients as having APR involvement and rater 2 diagnosed 28 (50.9%) as having APR involvement. There was moderate agreement (κ = 0.602, p < 0.001) between the two raters with regard to the evaluation of APR involvement. During surgery, the surgeon confirmed APR involvement in 13 (23.6%) patients. The sensitivity, specificity, PPV, and NPV of preoperative MRI for APR involvement were 69.2%, 76.2%, 47.4%, and 88.9%, respectively. The diagnostic accuracy of MRI for predicting APR involvement was 74.6%. CONCLUSION Preoperative rectal MRI provides accurate anatomical information regarding APR involvement with high conspicuity. However, MRI has relatively low sensitivity (< 70%) and a low PPV (< 50%) with regard to the assessment of APR involvement in rectal tumors. Both rater 1 and rater 2 evaluated these images as positive involvement of APR. The patient underwent laparoscopic low anterior resection after preoperative evaluation. However, during surgery, the surgeon evaluated APR involvement as negative, and the final pathologic staging was confirmed as T3.
Collapse
Affiliation(s)
- Ki Choon Sim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Beom Jin Park
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Min Ju Kim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Deuk Jae Sung
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Na Yeon Han
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Yeo Eun Han
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Jung-Myun Kwak
- Department of Surgery, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| |
Collapse
|
7
|
Piozzi GN, Baek SJ, Kwak JM, Kim J, Kim SH. Anus-Preserving Surgery in Advanced Low-Lying Rectal Cancer: A Perspective on Oncological Safety of Intersphincteric Resection. Cancers (Basel) 2021; 13:4793. [PMID: 34638278 PMCID: PMC8507715 DOI: 10.3390/cancers13194793] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022] Open
Abstract
The surgical management of low-lying rectal cancer, within 5 cm from the anal verge (AV), is challenging due to the possibility, or not, to preserve the anus with its sphincter muscles maintaining oncological safety. The standardization of total mesorectal excision, the adoption of neoadjuvant chemoradiotherapy, the implementation of rectal magnetic resonance imaging, and the evolution of mechanical staplers have increased the rate of anus-preserving surgeries. Moreover, extensive anatomy and physiology studies have increased the understanding of the complexity of the deep pelvis. Intersphincteric resection (ISR) was introduced nearly three decades ago as the ultimate anus-preserving surgery. The definition and indication of ISR have changed over time. The adoption of the robotic platform provides excellent perioperative results with no differences in oncological outcomes. Pushing the boundaries of anus-preserving surgeries has risen doubts on oncological safety in order to preserve function. This review critically discusses the oncological safety of ISR by evaluating the anatomical characteristics of the deep pelvis, the clinical indications, the role of distal and circumferential resection margins, the role of the neoadjuvant chemoradiotherapy, the outcomes between surgical approaches (open, laparoscopic, and robotic), the comparison with abdominoperineal resection, the risk factors for oncological outcomes and local recurrence, the patterns of local recurrences after ISR, considerations on functional outcomes after ISR, and learning curve and surgical education on ISR.
Collapse
Affiliation(s)
| | | | | | | | - Seon Hahn Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (G.N.P.); (S.-J.B.); (J.-M.K.); (J.K.)
| |
Collapse
|