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Ma Y, Ma D, Xu X, Li J, Guan Z. Progress of MRI in predicting the circumferential resection margin of rectal cancer: A narrative review. Asian J Surg 2024; 47:2122-2131. [PMID: 38331609 DOI: 10.1016/j.asjsur.2024.01.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/02/2024] [Accepted: 01/19/2024] [Indexed: 02/10/2024] Open
Abstract
Rectal cancer (RC) is the third most frequently diagnosed cancer worldwide, and the status of its circumferential resection margin (CRM) is of paramount significance for treatment strategies and prognosis. CRM involvement is defined as tumor touching or within 1 mm from the outermost part of tumor or outer border of the mesorectal or lymph node deposits to the resection margin. The incidence of involved CRM varied from 5.4 % to 36 %, which may associate with an in consistent definition of CRM, the quality of surgeries, and the different examination modalities. Although T and N status are essential factors in determining whether a patient should receive neoadjuvant therapy before surgery, CRM status is a powerful predictor of local and distant recurrence as well as survival rate. This review explores the significance of CRM, the various assessment methods, and the role of magnetic resonance imaging (MRI) and artificial intelligence-based MRI in predicting CRM status. MRI showed potential advantage in predicting CRM status with a high sensitivity and specificity compared to computed tomography (CT). We also discuss MRI advancements in RC imaging, including conventional MRI with body coil, high-resolution MRI with phased-array coil, and endorectal MRI. Along with a discussion of artificial intelligence-based MRI techniques to predict the CRM status of RCs before and after treatments.
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Affiliation(s)
- Yanqing Ma
- Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China.
| | - Dongnan Ma
- Yangming College of Ningbo University, Ningbo, Zhejiang, 315010, China.
| | - Xiren Xu
- Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China.
| | - Jie Li
- Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China.
| | - Zheng Guan
- Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, China.
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Ozaki K, Kawai K, Nozawa H, Sasaki K, Murono K, Emoto S, Iida Y, Ishii H, Yokoyama Y, Anzai H, Sonoda H, Sugihara K, Ishihara S. Therapeutic effects and limitations of chemoradiotherapy in advanced lower rectal cancer focusing on T4b. Int J Colorectal Dis 2021; 36:1525-1534. [PMID: 33937942 DOI: 10.1007/s00384-021-03936-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to elucidate the benefits and limitations of preoperative chemoradiotherapy (CRT) in rectal cancer treatment, specifically in T4b rectal cancer. METHODS This retrospective cohort study reviewed 1014 consecutive patients with clinical T3/4a/T4b adenocarcinomas of the lower rectum, who underwent total mesorectal excision at the Department of Surgical Oncology of the University of Tokyo Hospital and 22 referral institutions affiliated with the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer. Patients were divided into two cohorts: cohort 1 comprised 298 consecutive patients who underwent CRT followed by radical surgery and cohort 2 comprised 716 consecutive patients who underwent curative surgery without preoperative therapy. We assessed the prognostic differences between the two cohorts, focusing particularly on T stages. RESULTS In T3/4a patients, cohort 1 showed a significantly lower local recurrence rate than cohort 2 (4.8% vs. 9.4%, p=0.024), but not in T4b patients (23.5% vs. 16.0%, p=0.383). In contrast, no significant differences in survival were observed between T3/4a and T4b patients. T4b classification was found to be an independent predictive factor of local recurrence in cohort 1, but not in cohort 2. CONCLUSION In T4b rectal cancer, preoperative CRT demonstrated a limited benefit for local control and survival. In cases of suspected T4b rectal tumors, additional therapies such as induction chemotherapy to conventional CRT may contribute to better outcomes.
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Affiliation(s)
- Kosuke Ozaki
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Kazushige Kawai
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Koji Murono
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yuuki Iida
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroaki Ishii
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yuichiro Yokoyama
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroyuki Anzai
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kenichi Sugihara
- Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Low- Versus High-Risk Rectal Cancer Based on MRI Features: Outcomes in Patients Treated Without Neoadjuvant Chemoradiotherapy. AJR Am J Roentgenol 2018; 211:327-334. [PMID: 29927331 DOI: 10.2214/ajr.17.18980] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of this study was to compare the prognoses of patients with low- and high-risk rectal cancer detected by MRI who were treated without neoadjuvant chemoradiotherapy (NCRT) and to determine independent risk factors. MATERIALS AND METHODS This retrospective study included 185 patients with pathologically proven rectal adenocarcinoma who were treated without NCRT. Cancer was defined as high risk if one or more of the following factors were present: extramural depth of tumor invasion greater than 5 mm or stage T4a or T4b for tumor in the mid or high rectum; involvement of intersphincteric space, levators, or adjacent organs for tumor in the low rectum; extramural venous invasion (EMVI); or circumferential resection margin (CRM) involvement. Patients without any of those risk factors were placed in the low-risk group. The Kaplan-Meier method and Cox proportional hazards regression model were used to compare the survival outcomes between the two groups and to investigate the univariate and multivariate influences of the risk factors. RESULTS Cancer was deemed to be low risk in 65 (35.1%) patients and high risk in 120 (64.9%) patients. The two patient groups had statistically significant differences in 3-year actuarial overall survival (OS; 100% vs 88.3%, p = 0.0044), disease-free survival (DFS; 92.3% vs 60.0%, p < 0.0001), and local recurrence (LR; 1.5% vs 10.0%, p = 0.0297). CRM involvement was identified as an independent risk factor for OS (hazard ratio [HR], 4.78; 95% CI, 1.24-18.45), DFS (HR, 2.44; 95% CI, 1.24-4.81), and LR (HR, 3.92; 95% CI, 1.07-14.41). Moreover, EMVI was identified as an independent risk factor for DFS (HR, 2.46; 95% CI, 1.28-4.74). CONCLUSION The LR and long-term survival of patients in the low-risk group were more favorable than those of patients in the high-risk group. EMVI and CRM status were independent risk factors.
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Dagoglu N, Nedea E, Poylin V, Nagle D, Mahadevan A. Post operative stereotactic radiosurgery for positive or close margins after preoperative chemoradiation and surgery for rectal cancer. J Gastrointest Oncol 2016; 7:315-20. [PMID: 27284461 DOI: 10.21037/jgo.2015.11.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The incidence of positive margins after neoadjuvant chemoradiation and adequate surgery is very low. However, when patients do present with positive or close margins, they are at a risk of local failure and local therapy options are limited. We evaluated the role of stereotactic body radiotherapy (SBRT) in patients with positive or close margins after induction chemoradiation and total mesorectal excision. METHODS This is a retrospective evaluation of patients treated with SBRT after induction chemoradiation and surgery for positive or close margins. Seven evaluable patients were included. Fiducial seeds were place at surgery. The Cyberknife(TM) system was used for planning and treatment. Patients were followed 1 month after treatment and 3-6 months thereafter. Descriptive statistics and Kaplan-Meir method was used to repot the findings. RESULTS Seven patients (3 men and 4 women) were included in the study with a median follow-up of 23.5 months. The median initial radiation dose was 5,040 cGy (in 28 fractions) and the median SBRT dose was 2,500 cGy (in 5 fractions). The local control at 2 years was 100%. The overall survival at 1 and 2 years was 100% and 71% respectively. There was no Grade III or IV toxicity. CONCLUSIONS SBRT reirradiation is an effective and safe method to address positive or close margins after neoadjuvant chemoradiation and surgery for rectal cancer.
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Affiliation(s)
- Nergiz Dagoglu
- 1 Department of Radiation Oncology, Istanbul University, Istanbul, Turkey ; 2 Radiation Oncology, 3 Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Elena Nedea
- 1 Department of Radiation Oncology, Istanbul University, Istanbul, Turkey ; 2 Radiation Oncology, 3 Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Vitaliy Poylin
- 1 Department of Radiation Oncology, Istanbul University, Istanbul, Turkey ; 2 Radiation Oncology, 3 Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Deborah Nagle
- 1 Department of Radiation Oncology, Istanbul University, Istanbul, Turkey ; 2 Radiation Oncology, 3 Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Anand Mahadevan
- 1 Department of Radiation Oncology, Istanbul University, Istanbul, Turkey ; 2 Radiation Oncology, 3 Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Fazeli MS, Keramati MR. Rectal cancer: a review. Med J Islam Repub Iran 2015; 29:171. [PMID: 26034724 PMCID: PMC4431429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/24/2014] [Indexed: 11/22/2022] Open
Abstract
Rectal cancer is the second most common cancer in large intestine. The prevalence and the number of young patients diagnosed with rectal cancer have made it as one of the major health problems in the world. With regard to the improved access to and use of modern screening tools, a number of new cases are diagnosed each year. Considering the location of the rectum and its adjacent organs, management and treatment of rectal tumor is different from tumors located in other parts of the gastrointestinal tract or even the colon. In this article, we will review the current updates on rectal cancer including epidemiology, risk factors, clinical presentations, screening, and staging. Diagnostic methods and latest treatment modalities and approaches will also be discussed in detail.
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Affiliation(s)
- Mohammad Sadegh Fazeli
- 1 Associate Professor of Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Keramati
- 2 Assistant Professor of Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.
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Kim HJ, Choi GS, Park JS, Park SY. Comparison of intracorporeal single-stapled and double-stapled anastomosis in laparoscopic low anterior resection for rectal cancer: a case-control study. Int J Colorectal Dis 2013; 28:149-56. [PMID: 23014975 DOI: 10.1007/s00384-012-1582-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE Recently, a single-stapled technique (SST) was performed instead of the conventional double-stapled technique (DST) in laparoscopic low anterior resection for anastomosis, by placement of intracorporeal purse-string sutures on the distal rectum with transanal specimen extraction. This study aimed to compare the short-term outcomes between the two anastomotic techniques. METHODS Between July 2007 and April 2010, 60 patients underwent SST by laparoscopic or robotic procedure. These patients were matched 1:2 by age, gender, date of surgery, and tumor stage with 120 patients who underwent conventional DST in laparoscopic low anterior resection. RESULTS The robotic-assisted operative approach was used more frequently in the SST group than in the DST group (61.7 % vs. 3.3 %, p < 0.001). The mean operative time was 203.9 (range, 120-400) min for the SST group and 167.6 (range, 90-300) min for the DST group (p < 0.001). For specimen removal, the transanal approach was used in the SST group, while the transabdominal approach was used for the DST group. The pain score (visual analogue scale) of the SST group was lower (4.5 vs. 5.6, p < 0.001), although postoperative recovery was similar. Pathological examination revealed that the distal resection margin was significantly longer in the SST group (3.1 vs. 2.5 cm, p = 0.018). Postoperative morbidity including anastomotic leakage was similar in both groups. CONCLUSIONS SST yielded equivalent short-term outcomes when compared to conventional DST and provided the advantages of minimal access and a longer distal resection margin. Therefore, SST in lower anterior resection may be a useful alternative to conventional DST.
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Affiliation(s)
- Hye Jin Kim
- Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807, Hogukro, Buk-gu, Daegu 702-210, South Korea
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