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de’Angelis N, Marchegiani F, Martínez-Pérez A, Biondi A, Pucciarelli S, Schena CA, Pellino G, Kraft M, van Lieshout AS, Morelli L, Valverde A, Lupinacci RM, Gómez-Abril SA, Persiani R, Tuynman JB, Espin-Basany E, Ris F. Robotic, transanal, and laparoscopic total mesorectal excision for locally advanced mid/low rectal cancer: European multicentre, propensity score-matched study. BJS Open 2024; 8:zrae044. [PMID: 38805357 PMCID: PMC11132137 DOI: 10.1093/bjsopen/zrae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/11/2024] [Accepted: 04/01/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Total mesorectal excision (TME) is the standard surgery for low/mid locally advanced rectal cancer. The aim of this study was to compare three minimally invasive surgical approaches for TME with primary anastomosis (laparoscopic TME, robotic TME, and transanal TME). METHODS Records of patients undergoing laparoscopic TME, robotic TME, or transanal TME between 2013 and 2022 according to standardized techniques in expert centres contributing to the European MRI and Rectal Cancer Surgery III (EuMaRCS-III) database were analysed. Propensity score matching was applied to compare the three groups with respect to the complication rate (primary outcome), conversion rate, postoperative recovery, and survival. RESULTS A total of 468 patients (mean(s.d.) age of 64.1(11) years) were included; 190 (40.6%) patients underwent laparoscopic TME, 141 (30.1%) patients underwent robotic TME, and 137 (29.3%) patients underwent transanal TME. Comparative analyses after propensity score matching demonstrated a higher rate of postoperative complications for laparoscopic TME compared with both robotic TME (OR 1.80, 95% c.i. 1.11-2.91) and transanal TME (OR 2.87, 95% c.i. 1.72-4.80). Robotic TME was associated with a lower rate of grade A anastomotic leakage (2%) compared with both laparoscopic TME (8.8%) and transanal TME (8.1%) (P = 0.031). Robotic TME (1.4%) and transanal TME (0.7%) were both associated with a lower conversion rate to open surgery compared with laparoscopic TME (8.8%) (P < 0.001). Time to flatus and duration of hospital stay were shorter for patients treated with transanal TME (P = 0.003 and 0.001 respectively). There were no differences in operating time, intraoperative complications, blood loss, mortality, readmission, R0 resection, or survival. CONCLUSION In this multicentre, retrospective, propensity score-matched, cohort study of patients with locally advanced rectal cancer, newer minimally invasive approaches (robotic TME and transanal TME) demonstrated improved outcomes compared with laparoscopic TME.
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Affiliation(s)
- Nicola de’Angelis
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital, Ferrara (Cona), Italy
| | - Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
- University Paris Cité, Paris, France
| | - Aleix Martínez-Pérez
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
- Biosanitary Research Institute, Valencian International University (VIU), Valencia, Spain
| | - Alberto Biondi
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Salvatore Pucciarelli
- General Surgery 3, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Carlo Alberto Schena
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital, Ferrara (Cona), Italy
| | - Gianluca Pellino
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Miquel Kraft
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Annabel S van Lieshout
- Department of Surgery, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alain Valverde
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses, Croix Saint-Simon, Paris, France
| | - Renato Micelli Lupinacci
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses, Croix Saint-Simon, Paris, France
| | - Segundo A Gómez-Abril
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Roberto Persiani
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eloy Espin-Basany
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, University Hospital Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Frederic Ris
- Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
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Yu M, Yuan Z, Li R, Shi B, Wan D, Dong X. Interpretable machine learning model to predict surgical difficulty in laparoscopic resection for rectal cancer. Front Oncol 2024; 14:1337219. [PMID: 38380369 PMCID: PMC10878416 DOI: 10.3389/fonc.2024.1337219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/15/2024] [Indexed: 02/22/2024] Open
Abstract
Background Laparoscopic total mesorectal excision (LaTME) is standard surgical methods for rectal cancer, and LaTME operation is a challenging procedure. This study is intended to use machine learning to develop and validate prediction models for surgical difficulty of LaTME in patients with rectal cancer and compare these models' performance. Methods We retrospectively collected the preoperative clinical and MRI pelvimetry parameter of rectal cancer patients who underwent laparoscopic total mesorectal resection from 2017 to 2022. The difficulty of LaTME was defined according to the scoring criteria reported by Escal. Patients were randomly divided into training group (80%) and test group (20%). We selected independent influencing features using the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression method. Adopt synthetic minority oversampling technique (SMOTE) to alleviate the class imbalance problem. Six machine learning model were developed: light gradient boosting machine (LGBM); categorical boosting (CatBoost); extreme gradient boost (XGBoost), logistic regression (LR); random forests (RF); multilayer perceptron (MLP). The area under receiver operating characteristic curve (AUROC), accuracy, sensitivity, specificity and F1 score were used to evaluate the performance of the model. The Shapley Additive Explanations (SHAP) analysis provided interpretation for the best machine learning model. Further decision curve analysis (DCA) was used to evaluate the clinical manifestations of the model. Results A total of 626 patients were included. LASSO regression analysis shows that tumor height, prognostic nutrition index (PNI), pelvic inlet, pelvic outlet, sacrococcygeal distance, mesorectal fat area and angle 5 (the angle between the apex of the sacral angle and the lower edge of the pubic bone) are the predictor variables of the machine learning model. In addition, the correlation heatmap shows that there is no significant correlation between these seven variables. When predicting the difficulty of LaTME surgery, the XGBoost model performed best among the six machine learning models (AUROC=0.855). Based on the decision curve analysis (DCA) results, the XGBoost model is also superior, and feature importance analysis shows that tumor height is the most important variable among the seven factors. Conclusions This study developed an XGBoost model to predict the difficulty of LaTME surgery. This model can help clinicians quickly and accurately predict the difficulty of surgery and adopt individualized surgical methods.
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Affiliation(s)
| | | | | | | | - Daiwei Wan
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoqiang Dong
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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Yasar NF, Gundogdu E, Yilmaz AS, Badak B, Bayav FD, Ozen A, Oner S. Can 3D radiological calculations predict operational difficulties for rectal cancer?: A single center retrospective analysis. Medicine (Baltimore) 2024; 103:e36961. [PMID: 38241536 PMCID: PMC10798752 DOI: 10.1097/md.0000000000036961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024] Open
Abstract
Low anterior resection, performing total mesorectal excision with appropriate pelvic dissection to prevent local recurrence, is probably the most challenging type of surgery in colorectal surgery, especially in a narrow pelvis. In this study, we aimed to predict the operation difficulty of rectal cancer by comparing the operation time with 2D and 3D pelvimetry. Sixty-six patients who underwent total mesorectal excision after neoadjuvant chemoradiotherapy due to primary rectal cancer located in the middle and lower rectum (10 cm from the anus) were included in the study. Surgery notes were reviewed and data on demographic factors, tumor stage, duration of surgery, and types of surgery were collected, as well as pelvimetric parameters. All protocols had 2D T2-weighted sequences in 3 planes (axial, sagittal, and coronal). Pelvimetric measurements were made by measuring 8 pelvic lengths and 2 angles. Pelvis and tumor volume were measured by manual margin monitoring. In each slice, both pelvis and tumor boundaries were manually drawn individually in the sagittal plane. Pelvis and tumor volumes were calculated from the set of adjacent images by summing slice thickness and products of area measurements within the pelvis and tumor boundaries. In our results, no correlation was observed with operation time, including pelvic volume. Exception for this were interacetabular distance and tumor volume. In the regression test, the only parameter that correlated with the operation time was tumor volume. In conclusion, we believe that tumor volumetric calculations may be useful in predicting difficult distal rectal carcinoma surgeries.
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Affiliation(s)
- Necdet Fatih Yasar
- Department of General Surgery, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
| | - Elif Gundogdu
- Department of Radiology, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
| | - Arda Sakir Yilmaz
- Department of General Surgery, Yunus Emre State Hospital, Eskişehir, Turkey
| | - Bartu Badak
- Department of General Surgery, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
| | - Fatma Didem Bayav
- Department of Radiology, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
| | - Alaattin Ozen
- Department of Radiation Oncology, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
| | - Setenay Oner
- Department of Biostatistics, Faculty of Medicine, Eskisehir Osmangazi University, Eskişehir, Turkey
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Pi F, Tang G, Xie C, Cao Y, Yang S, Wei Z. Pathologic complete response to TNT + camrelizumab for rectal cancer with surgical anus-preservation: case report and literature review. Front Surg 2023; 10:1192569. [PMID: 37470045 PMCID: PMC10352850 DOI: 10.3389/fsurg.2023.1192569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/17/2023] [Indexed: 07/21/2023] Open
Abstract
Background This case report demonstrates the efficacy of total neoadjuvant therapy (TNT) based on pathological complete response (PCR). We also discuss the surgical approach to preserving the anus and its perioperative management. Case presentaion The patient was a 26-year-old woman, with blood in the stool and stool thinning for over two months. Preoperative examination revealed locally advanced rectal cancer invading the left anal raphe and enlarged lymph nodes adjacent to the left internal iliac vessels. The lesion was preoperatively classified as T4bN1bM0 IIIC. Considering the size and depth of the tumor, it was difficult to have sufficient margins for radical resection, and the tumor was too close to the anal orifice. Considering the patient's youth and strong desire to preserve the anus, it was decided to use TNT combined with a camrelizumab regimen. After the entire course of neoadjuvant radiotherapy, the tumor size significantly reduced in fibrotic manifestations, and no enlargement of the lymph nodes adjacent to the left internal iliac vessels was observed. She underwent robotic laparoscopic ultra-low anterior rectal resection, left lateral lymph node dissection, and temporary ileostomy, and no significant residue was observed after all bowel tubes were taken for examination, nor was there cancerous involvement at the distal or radial cut edges, or metastasis. The patient was discharged nine days postoperatively, and no major complications were detected. Follow-up was performed without adjuvant chemotherapy. Conclusions TNT may be a better surgical option for preserving the anus and for complete radical resection in patients with LARC for whom Miles' resection is indicated.
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Yuan Y, Tong D, Liu M, Lu H, Shen F, Shi X. An MRI-based pelvimetry nomogram for predicting surgical difficulty of transabdominal resection in patients with middle and low rectal cancer. Front Oncol 2022; 12:882300. [PMID: 35957878 PMCID: PMC9357897 DOI: 10.3389/fonc.2022.882300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The current work aimed to develop a nomogram comprised of MRI-based pelvimetry and clinical factors for predicting the difficulty of rectal surgery for middle and low rectal cancer (RC). Methods Consecutive mid to low RC cases who underwent transabdominal resection between June 2020 and August 2021 were retrospectively enrolled. Univariable and multivariable logistic regression analyses were carried out for identifying factors (clinical factors and MRI-based pelvimetry parameters) independently associated with the difficulty level of rectal surgery. A nomogram model was established with the selected parameters for predicting the probability of high surgical difficulty. The predictive ability of the nomogram model was assessed by the receiver operating characteristic (ROC) curve and decision curve analysis (DCA). Results A total of 122 cases were included. BMI (OR = 1.269, p = 0.006), pelvic inlet (OR = 1.057, p = 0.024) and intertuberous distance (OR = 0.938, p = 0.001) independently predicted surgical difficulty level in multivariate logistic regression analysis. The nomogram model combining these predictors had an area under the ROC curve (AUC) of 0.801 (95% CI: 0.719–0.868) for the prediction of a high level of surgical difficulty. The DCA suggested that using the nomogram to predict surgical difficulty provided a clinical benefit. Conclusions The nomogram model is feasible for predicting the difficulty level of rectal surgery, utilizing MRI-based pelvimetry parameters and clinical factors in mid to low RC cases.
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Affiliation(s)
- Yuan Yuan
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Dafeng Tong
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
| | - Minglu Liu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Haidi Lu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Fu Shen
- Department of Radiology, Changhai Hospital, Shanghai, China
- *Correspondence: Xiaohui Shi, ; Fu Shen,
| | - Xiaohui Shi
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, China
- *Correspondence: Xiaohui Shi, ; Fu Shen,
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Ye C, Wang X, Sun Y, Deng Y, Huang Y, Chi P. A nomogram predicting the difficulty of laparoscopic surgery for rectal cancer. Surg Today 2021; 51:1835-1842. [PMID: 34296313 DOI: 10.1007/s00595-021-02338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/02/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to identify the risk factors associated with performing a difficult laparoscopic radical resection of rectal cancer, and to establish a predictive nomogram to help individual clinical treatment decisions. METHODS A total of 977 patients with rectal cancer who underwent laparoscopic radical resection between January 2014 and December 2016 were enrolled in this study. The difficulty of laparoscopic-assisted rectal resection (LARR) was defined according to the scoring criteria reported by Escal. A logistic regression analysis was performed to identify the variables that may affect the difficulty of LARR, and a nomogram predicting the surgical difficulty was created. RESULTS A multivariate analysis demonstrated that a BMI > 28 kg/m2, the distance between the tumor and the anal margin ≤ 5 cm, the maximum transverse tumor diameter > 3 cm tumor, interspinous distance < 10 cm, history of abdominal surgery, and preoperative radiotherapy were independent risk factors and they were, therefore, included in the predictive nomogram for identifying a difficult LARR. CONCLUSIONS This study defined a difficult LARR and identified independent risk factors for a difficult operation and created a predictive nomogram for difficult LARR. This nomogram may facilitate the stratification of patients at risk for being associated with a difficult LARR for rectal cancer.
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Affiliation(s)
- Chengwei Ye
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China.,Department of Gastrointestinal Surgery, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, 1028 Anji South Road, 362000, Fujian Province, People's Republic of China
| | - Xiaojie Wang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China.,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China
| | - Yanwu Sun
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China.,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China
| | - Yu Deng
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China
| | - Ying Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China. .,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China.
| | - Pan Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China. .,Training Center of Minimally Invasive Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China.
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Hong JSY, Brown KGM, Waller J, Young CJ, Solomon MJ. Author's reply to commentary on "The role of MRI pelvimetry in predicting technical difficulty and outcomes of open and minimally invasive total mesorectal excision: a systematic review". Tech Coloproctol 2021; 25:983. [PMID: 34181153 DOI: 10.1007/s10151-021-02478-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Affiliation(s)
- J S-Y Hong
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia. .,The Institute of Academic Surgery at RPA, Sydney, Australia. .,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia. .,University of Sydney, Sydney, Australia.
| | - K G M Brown
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,The Institute of Academic Surgery at RPA, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - J Waller
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - C J Young
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,The Institute of Academic Surgery at RPA, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - M J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,The Institute of Academic Surgery at RPA, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
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Sun Y, Chen J, Ye C, Lin H, Lu X, Huang Y, Chi P. Pelvimetric and Nutritional Factors Predicting Surgical Difficulty in Laparoscopic Resection for Rectal Cancer Following Preoperative Chemoradiotherapy. World J Surg 2021; 45:2261-2269. [PMID: 33821350 DOI: 10.1007/s00268-021-06080-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 01/01/2023]
Abstract
AIM Laparoscopic total mesorectal excision (LaTME) following preoperative chemoradiotherapy (PCRT) in locally advanced rectal cancer (LARC) is technically demanding. The present study is intended to evaluate predictive factors of surgical difficulty of LaTME following PCRT by using pelvimetric and nutritional factors. METHOD Consecutive LARC patients receiving LaTME after PCRT were included. Surgical difficulty was classified based upon intraoperative (operation time, blood loss, and conversion) and postoperative outcomes (postoperative hospital stay and morbidities). Pelvimetry was performed using preoperative T2-weighted MRI. Nutritional factors such as albumin-to-globulin ratio (AGR) and prognostic nutritional index (PNI) were calculated. Multivariable logistic analysis was used to identify predictors of high surgical difficulty. A predictive nomogram was developed and validated internally. RESULTS Among 294 patients included, 36 (12.4%) patients were graded as high surgical difficulty. Logistic regression analysis demonstrated that previous abdominal surgery (OR = 6.080, P = 0.001), tumor diameter (OR = 1.732, P = 0.003), intersphincteric resection (vs. low anterior resection, OR = 13.241, P < 0.001), interspinous distance (OR = 0.505, P = 0.009), and preoperative AGR (OR = 0.041, P = 0.024) were independently predictive of high surgical difficulty of LaTME after PCRT. Then, a predictive nomogram was built (C-index = 0.867). CONCLUSION Besides previous abdominal surgery, type of surgery (intersphincteric resection), tumor diameter, and interspinous distance, we found that preoperative AGR could be useful for the prediction of surgical difficulty of LaTME after PCRT. A predictive nomogram for surgical difficulty may aid in planning an appropriate approach for rectal cancer surgery after PCRT.
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Affiliation(s)
- Yanwu Sun
- Colorectal Surgery Department, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, PR China
| | - Jianhua Chen
- Radiology Department, Fujian Medical University Union Hospital, Fuzhou, PR China
| | - Chengwei Ye
- Colorectal Surgery Department, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, PR China
| | - Huiming Lin
- Colorectal Surgery Department, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, PR China
| | - Xingrong Lu
- Colorectal Surgery Department, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, PR China
| | - Ying Huang
- Colorectal Surgery Department, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, PR China.
| | - Pan Chi
- Colorectal Surgery Department, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, PR China.
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Chen J, Sun Y, Chi P, Sun B. MRI pelvimetry-based evaluation of surgical difficulty in laparoscopic total mesorectal excision after neoadjuvant chemoradiation for male rectal cancer. Surg Today 2021; 51:1144-1151. [PMID: 33420827 PMCID: PMC8215037 DOI: 10.1007/s00595-020-02211-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/10/2020] [Indexed: 12/16/2022]
Abstract
Purpose Laparoscopic total mesorectal excision (LaTME) is technically demanding in rectal cancer after neoadjuvant chemoradiotherapy (NCRT). This study aimed to predict the surgical difficulty of LaTME after NCRT based on pelvimetric parameters. Methods This study enrolled 147 patients who underwent LaTME after NCRT. The surgical difficulty was graded as high or low according to the operative time, estimated blood loss, conversion to open surgery, postoperative hospital stay, and postoperative complications. Pelvimetry parameters were collected based on preoperative MRI. A logistic regression analysis was performed to identify predictors of high surgical difficulty, and a nomogram was developed. Results Totally, 18 (12.2%) patients were graded as high surgical difficulty. High surgical difficulty was correlated with a shorter interspinous distance (P = 0.014), a small angle α and γ (P = 0.008, P = 0.008, respectively), and a larger mesorectal area and mesorectal fat area (P = 0.041, P = 0.046, respectively). Tumor distance from the anal verge (OR = 0.619, P = 0.024), tumor diameter (OR = 3.747, P = 0.004), interspinous distance (OR = 0.127, P = 0.007), and angle α (OR = 0.821, P = 0.039) were independent predictors of high surgical difficulty. A predictive nomogram was developed with a C-index of 0.867. Conclusion A shorter tumor distance from the anal verge, larger tumor diameter, shorter interspinous distance, and smaller angle α could help to predict high surgical difficulty of LaTME in male LARC patients after NCRT. Supplementary Information The online version contains supplementary material available at 10.1007/s00595-020-02211-3.
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Affiliation(s)
- Jianhua Chen
- Department of Radiology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Yanwu Sun
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, People's Republic of China
| | - Pan Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, People's Republic of China
| | - Bin Sun
- Department of Radiology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China.
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Lorenzon L, Bini F, Landolfi F, Quinzi S, Balducci G, Marinozzi F, Biondi A, Persiani R, D’Ugo D, Tirelli F, Iannicelli E. 3D pelvimetry and biometric measurements: a surgical perspective for colorectal resections. Int J Colorectal Dis 2021; 36:977-986. [PMID: 33230658 PMCID: PMC8026460 DOI: 10.1007/s00384-020-03802-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Male sex, high BMI, narrow pelvis, and bulky mesorectum were acknowledged as clinical variables correlated with a difficult pelvic dissection in colorectal surgery. This paper aimed at comparing pelvic biometric measurements in female and male patients and at providing a perspective on how pelvimetry segmentation may help in visualizing mesorectal distribution. METHODS A 3D software was used for segmentation of DICOM data of consecutive patients aged 60 years, who underwent elective abdominal CT scan. The following measurements were estimated: pelvic inlet, outlet, and depth; pubic tubercle height; distances from the promontory to the coccyx and to S3/S4; distance from S3/S4 to coccyx's tip; ischial spines distance; pelvic tilt; offset angle; pelvic inlet angle; angle between the inlet/sacral promontory/coccyx; angle between the promontory/coccyx/pelvic outlet; S3 angle; and pelvic inlet to pelvic depth ratio. The measurements were compared in males and females using statistical analyses. RESULTS Two-hundred patients (M/F 1:1) were analyzed. Out of 21 pelvimetry measurements, 19 of them documented a significant mean difference between groups. Specifically, female patients had a significantly wider pelvic inlet and outlet but a shorter pelvic depth, and promontory/sacral/coccyx distances, resulting in an augmented inlet/depth ratio when comparing with males (p < 0.0001). The sole exceptions were the straight conjugate (p = 0.06) and S3 angle (p = 0.17). 3D segmentation provided a perspective of the mesorectum distribution according to the pelvic shape. CONCLUSION Significant differences in the structure of pelvis exist in males and females. Surgeons must be aware of the pelvic shape when approaching the rectum.
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Affiliation(s)
- Laura Lorenzon
- grid.8142.f0000 0001 0941 3192General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy ,grid.417007.5Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, RM Italy
| | - Fabiano Bini
- grid.7841.aDepartment of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, via Eudossiana 18, 00184 Rome, Italy
| | - Federica Landolfi
- grid.417007.5Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, RM Italy
| | - Serena Quinzi
- grid.7841.aDepartment of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, via Eudossiana 18, 00184 Rome, Italy
| | - Genoveffa Balducci
- grid.417007.5Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, RM Italy
| | - Franco Marinozzi
- grid.7841.aDepartment of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, via Eudossiana 18, 00184 Rome, Italy
| | - Alberto Biondi
- grid.8142.f0000 0001 0941 3192General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Roberto Persiani
- grid.8142.f0000 0001 0941 3192General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Domenico D’Ugo
- grid.8142.f0000 0001 0941 3192General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Flavio Tirelli
- grid.8142.f0000 0001 0941 3192General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Elsa Iannicelli
- grid.417007.5Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00185 Rome, RM Italy
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11
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Risk factors for suboptimal laparoscopic surgery in rectal cancer patients. Langenbecks Arch Surg 2020; 406:309-318. [PMID: 33244719 DOI: 10.1007/s00423-020-02029-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 11/05/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Laparoscopic surgery for rectal cancer is technically complex. This study aimed to identify risk factors for suboptimal laparoscopic surgery (involved margins, incomplete mesorectal excision, and/or conversion to open surgery) in patients with rectal cancer. METHODS We included patients undergoing laparoscopic anterior resection for rectal cancer between June 2009 and June 2018. We defined the outcome variable suboptimal laparoscopic surgery as conversion to open surgery or inadequate histopathological specimens (margins < 1 mm or involved and/or poor-quality mesorectal excision). To identify independent predictors of suboptimal laparoscopic surgery, we analyzed 15 prospectively recorded demographic, clinical, and anthropometric variables obtained from our rectal cancer unit's database. Subanalyses examined the same variables with respect to conversion and to inadequate histopathological specimens. RESULTS Of the 323 patients included, 91 (28.2%) had suboptimal laparoscopic surgery. In the multivariate analysis, the independent factors associated with all suboptimal laparoscopic surgery were tumor location ≤ 5 cm from the anal verge (OR = 2.95, 0.95% CI 1.32-6.60; p = 0.008) and the intertuberous distance (OR = 0.79, 0.95% CI 0.65-0.96; p = 0.019). In the subanalyses, the promontorium-retropubic axis was an independent predictor of conversion (OR 0.70, 0.95% CI 0.51-0.96; p = 0.026), and tumor location ≤ 5 cm from the anal verge (OR 3.71, 0.95% 1.51-9.15; p = 0.004) was an independent predictor of inadequate histopathological specimens. CONCLUSIONS Predictive factors for suboptimal laparoscopic anterior resection for rectal cancer were tumor location and the intertuberous distance. These results could help surgeons decide whether to use other surgical approaches in complex cases. TRIAL REGISTRATION The study was registered at Clinicaltrials.org (No. NCT03107650).
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Hosseini SV, Rezaianzadeh A, Rahimikazerooni S, Ghahramani L, Bananzadeh A. Prognostic Factors Affecting Short- and Long-Term Recurrence-Free Survival of Patients with Rectal Cancer using Cure Models: A Cohort Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2020; 45:333-340. [PMID: 33060876 PMCID: PMC7519398 DOI: 10.30476/ijms.2020.72735.0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Understanding the prognostic factors affecting the recurrence-free survival (RFS) of patients with rectal cancer (RC) is the mainstay of care. The present
study aimed to identify factors affecting both short- and long-term RFS of patients with RC using semiparametric mixture cure models. Methods: The data were obtained from the database of the Colorectal Research Center of Shiraz University of Medical Sciences, Shiraz, Iran, which was collected during
2007-2017. To determine the factors affecting recurrence, cure models were applied to short-term and long-term RFS of patients with RC separately. The cure rate
was calculated using the smcure package in R 3.5.1 (2018-07-02) software. P<0.05 was considered statistically significant. Results: Out of the 376 eligible patients with RC, 75.8% of men and 74.5% of women were long-term survivors. The mean age of the patients was 57.0±13.8 years.
Lymph node ratio (LNR)≤0.2 increased the probability of short-term RFS. The prominent factors affecting long-term RFS were body mass index (BMI)<25 kg/m2
(OR=1.98, P=0.047), tumor-node-metastasis (TNM) stage (OR=6.48, P<0.001), abdominal pain (OR=2.15, P=0.007), and computed tomography (CT) scan detected
pelvic lymph nodes (OR=3.40, P=0.01). Over a 9-year follow-up period, the empirical and estimated values of cure rates were 75.3% and 83.9%, respectively. Conclusion: The results showed that factors affecting short-term RFS might be different from long-term RFS. A lower BMI was related to a poorer prognosis
in patients with RC. Early diagnosis leads to a lower TNM stage and could increase the probability of long-term RFS.
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Affiliation(s)
- Seyed Vahid Hosseini
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rezaianzadeh
- Colorectal Research Center, Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Leila Ghahramani
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alimohammad Bananzadeh
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
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13
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Yamaguchi Y, Kamai T, Kobayashi M. Comparative accuracy of the Lilium α-200 portable ultrasound bladder scanner and conventional transabdominal ultrasonography for postvoid residual urine volume measurement in association with the clinical factors involved in measurement errors. Neurourol Urodyn 2020; 40:183-192. [PMID: 33022795 DOI: 10.1002/nau.24530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/20/2020] [Accepted: 09/20/2020] [Indexed: 01/19/2023]
Abstract
AIM We examined the comparative accuracy of the portable ultrasound bladder scanner, Lilium α-200, and conventional ultrasonography (CUS) in bladder volume measurement. We also examined factors that could lead to measurement errors. METHODS Postvoid residual (PVR) volume was measured by Lilium α-200 and CUS with catheterized volume as a comparator in 224 consecutive men, of which 109 were also measured for the serially inflated bladder with saline. The measurement accuracy with respect to the actual volume was evaluated by calculating the error volume (EV), % error volume (%EV), and their absolute values. Absolute %EV of ≤20% was designated as nonerror. The measurement of prostate volume, abdominal thickness, and pelvimetry was performed on magnetic resonance images. RESULTS PVR volumes measured by CUS are better correlated with actual volumes (r = .779) than those of Lilium α-200 (r = .606). When the measurement accuracy was indicated by absolute values of EV and %EV, CUS provided a more accurate estimate (21 ± 21 ml, 60 ± 42%) than Lilium α-200 (32 ± 45 ml, 91 ± 142%). The frequency of error was significantly increased at lower bladder volumes. Overestimation was associated with larger prostate size for the Lilium α-200, while underestimation was associated with greater bladder flattening for both methods. CONCLUSION PVR volumes measured by Lilium α-200 were fairly correlated with actual volumes. However, their relative errors were too large to correctly predict the actual volume. Flattened bladder and a large prostate may hinder accurate measurements. Consequently, Lilium α-200 is not superior to CUS and its feasibility is limited to when the precise measurement is not required.
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Affiliation(s)
| | - Takao Kamai
- Department of Urology, Dokkyo Medical University, Tochigi, Japan
| | - Minoru Kobayashi
- Department of Urology, Utsunomiya Memorial Hospital, Tochigi, Japan
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14
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Martínez-Pérez A, Espin E, Pucciarelli S, Ris F, de'Angelis N. Commentary on "The role of MRI pelvimetry in predicting technical difficulty and outcomes of open and minimally invasive total mesorectal excision: a systematic review". Tech Coloproctol 2020; 25:981-982. [PMID: 32915336 DOI: 10.1007/s10151-020-02343-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/03/2020] [Indexed: 12/18/2022]
Affiliation(s)
- A Martínez-Pérez
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - E Espin
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | - S Pucciarelli
- 1st Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - F Ris
- Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - N de'Angelis
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
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15
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Hong JSY, Brown KGM, Waller J, Young CJ, Solomon MJ. The role of MRI pelvimetry in predicting technical difficulty and outcomes of open and minimally invasive total mesorectal excision: a systematic review. Tech Coloproctol 2020; 24:991-1000. [PMID: 32623536 DOI: 10.1007/s10151-020-02274-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/20/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The difficulty of performing total mesorectal excision (TME) for rectal cancer partly relies on the surgeon's subjective assessment of the individual patient's pelvic anatomy and tumour characteristics, which generally influences the choice of platform used (open, laparoscopic, robotic or trans-anal surgery). Recent studies have found associations between several anatomical pelvic measurements and surgical difficulty. The aim of this study was to systematically review existing data reporting the use of magnetic resonance imaging (MRI)-based pelvic measurements to predict technical difficulty and outcomes of TME, and determine whether pelvimetry could optimise patient-specific selection of a particular surgical approach. METHODS MEDLINE, Embase and Cochrane Library databases were systematically searched for studies reporting MRI-based pelvic measurements in patients undergoing surgery for rectal cancer, and the effect of these measurements on surgical difficulty. RESULTS Eleven studies reporting the association between MRI-pelvimetry measurements and rectal cancer surgical outcomes were included. Indicators for surgical difficulty used in the included studies were involved circumferential resection margin, longer operative time, incomplete TME, higher blood loss, anastomotic leak, conversion to open surgery and overall complications. Bony pelvic measurements which were associated with increased surgical difficulty in more than one study were a smaller interspinous distance, a smaller intertubercle distance, a smaller pelvic inlet and larger pubic tubercle height. Two studies identified larger mesorectal fat area as a predictor of surgical difficulty. CONCLUSIONS Bony pelvic measurements may predict surgical difficulty during TME, however, use of different indicators of difficulty limit comparison between studies. Early data suggest MRI soft tissue measurements may predict surgical difficulty and warrants further investigation.
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Affiliation(s)
- J S-Y Hong
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia. .,Institute of Academic Surgery at RPA, Royal Prince Alfred Hospital, Missenden Road, PO Box M40, Camperdown, NSW, 2050, Australia. .,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia. .,Central Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, Australia.
| | - K G M Brown
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,Institute of Academic Surgery at RPA, Royal Prince Alfred Hospital, Missenden Road, PO Box M40, Camperdown, NSW, 2050, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - J Waller
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - C J Young
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,Institute of Academic Surgery at RPA, Royal Prince Alfred Hospital, Missenden Road, PO Box M40, Camperdown, NSW, 2050, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, Australia
| | - M J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney, Australia.,Institute of Academic Surgery at RPA, Royal Prince Alfred Hospital, Missenden Road, PO Box M40, Camperdown, NSW, 2050, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, Faculty of Health and Medicine, University of Sydney, Sydney, Australia
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16
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Abstract
Despite advances in technique, surgical resection of rectal cancer remains a morbid procedure that can lead a profound decrease in a patient's quality of life. A novel method of management, termed "Non-operative management" (NOM), mirrors the management of anal carcinoma. Patients undergo definitive treatment with only chemotherapy and radiation, with resection reserved only for salvage. Current data is encouraging- both in reduction in morbidity and similar, if not superior oncologic results. However, there are a number of barriers to the wide adoption of this practice. This manuscript seeks to describe the rationale and execution of NOM as well as present the current data and pitfalls of the approach.
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Affiliation(s)
- Jonathan B Greer
- Johns Hopkins University School of Medicine, Department of Surgery, Division of Surgical Oncology, Baltimore, MD
| | - Alexander T Hawkins
- Vanderbilt University Medical Center, Division of General Surgery, Section of Colon & Rectal Surgery, Nashville, TN
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17
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de'Angelis N, Pigneur F, Martínez-Pérez A, Vitali GC, Landi F, Gómez-Abril SA, Assalino M, Espin E, Ris F, Luciani A, Brunetti F. Assessing surgical difficulty in locally advanced mid-low rectal cancer: the accuracy of two MRI-based predictive scores. Colorectal Dis 2019; 21:277-286. [PMID: 30428156 DOI: 10.1111/codi.14473] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/29/2018] [Indexed: 02/08/2023]
Abstract
AIM Predicting surgical difficulty is a critical factor in the management of locally advanced rectal cancer (LARC). This study evaluates the accuracy and external validity of a recently published morphometric score to predict surgical difficulty and additionally proposes a new score to identify preoperatively LARC patients with a high risk of having a difficult surgery. METHODS This is a retrospective study based on the European MRI and Rectal Cancer Surgery (EuMaRCS) database, including patients with mid/low LARC who were treated with neoadjuvant chemoradiation therapy and laparoscopic total mesorectal excision (L-TME) with primary anastomosis. For all patients, pretreatment and restaging MRI were available. Surgical difficulty was graded as high and low based upon a composite outcome, including operative (e.g. duration of surgery) and postoperative variables (e.g. hospital stay). Score accuracy was assessed by estimating sensitivity, specificity and area under the receiver operating characteristic curve (AROC). RESULTS In a total of 136 LARC patients, 17 (12.5%) were graded as high surgical difficulty. The previously published score (calculated on body mass index, intertuberous distance, mesorectal fat area, type of anastomosis) showed low predictive value (sensitivity 11.8%; specificity 92.4%; AROC 0.612). The new EuMaRCS score was developed using the following significant predictors of surgical difficulty: body mass index > 30, interspinous distance < 96.4 mm, ymrT stage ≥ T3b and male sex. It demonstrated high accuracy (AROC 0.802). CONCLUSION The EuMaRCS score was found to be more sensitive and specific than the previous score in predicting surgical difficulty in LARC patients who are candidates for L-TME. However, this score has yet to be externally validated.
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Affiliation(s)
- N de'Angelis
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - F Pigneur
- Department of Radiology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - A Martínez-Pérez
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - G C Vitali
- Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - F Landi
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - S A Gómez-Abril
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - M Assalino
- Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - E Espin
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - F Ris
- Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - A Luciani
- Department of Radiology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
| | - F Brunetti
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
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