Predictors of surgical outcomes and survival in rectal cancer patients undergoing laparoscopic total mesorectal excision after neoadjuvant chemoradiation therapy: the interest of pelvimetry and restaging magnetic resonance imaging studies.
Por:
de'Angelis N, Pigneur F, Martínez-Pérez A, Vitali GC, Landi F, Torres-Sánchez T, Rodrigues V, Memeo R, Bianchi G, Brunetti F, Espin E, Ris F, Luciani A and EuMaRCS Study Group
Publicada:
18 may 2018
Categoría:
Oncology
Resumen:
Background: Locally advanced rectal cancer (LARC) requires a multimodal
therapy tailored to the patient and tumor characteristics. Pretreatment
magnetic resonance imaging (MRI) is necessary to stage the primary
tumor, while restaging MRI, which is not systematically performed, may
be of interest to identify poor responders to neoadjuvant chemoradiation
therapy (NCRT), and redefine therapeutic approach. The EuMaRCS study
group aimed to investigate the role and accuracy of pretreatment
(including pelvimetry) and restaging MRIs in predicting surgical
difficulties and surgical outcomes in LARC therapy.
Methods: Patients with mid or low LARC who were administered NCRT, who
underwent laparoscopic total mesorectal excision, and for whom
pretreatment and restaging MRIs were available, were included.
Results: MRIs of 170 patients (median age: 61 years) were reanalyzed by
the same radiologist. Pelvimetry differed significantly between males
and females, but no gender difference was noted in the clinical and
tumor characteristics. Tumor volume and tumor height assessed on the
restaging MRI were associated, respectively, with operative time and
estimated blood loss. Conversion was predicted by tumor volume,
interischial distance and pubic tubercle height. The quality of the
surgical resection was found to be a predictor of overall and
disease-free survival. The sensitivity and specificity of tumor
regression grade 1 to identify a pathologic complete response were 76.9%
and 89.3%, respectively.
Conclusions: In LARC management, pelvimetry and restaging MRI may be
useful to predict surgical difficulties and surgical outcomes. However,
the main independent predictor of patient survival appears to be the
achievement of a successful surgical resection.
Filiaciones:
de'Angelis N:
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
Pigneur F:
Department of Radiology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
:
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
Vitali GC:
Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
Landi F:
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
:
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
Rodrigues V:
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
Memeo R:
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
Bianchi G:
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
Brunetti F:
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
Espin E:
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
Ris F:
Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
Luciani A:
Department of Radiology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
|