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Factors related to preoperative assessment of the circumferential resection margin and the extent of mesorectal invasion by magnetic resonance imaging in rectal cancer: a prospective comparison study

Authors
 Young-Wan Kim  ;  Seung-Whan Cha  ;  Juyon Pyo  ;  Nam-Kyu Kim  ;  Byung-Soh Min  ;  Myeong-Jin Kim  ;  Hoguen Kim 
Citation
 WORLD JOURNAL OF SURGERY, Vol.33(9) : 1952-1960, 2009 
Journal Title
WORLD JOURNAL OF SURGERY
ISSN
 0364-2313 
Issue Date
2009
MeSH
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Magnetic Resonance Imaging/methods* ; Male ; Middle Aged ; Neoplasm Invasiveness/pathology ; Neoplasm Staging ; Predictive Value of Tests ; Preoperative Care ; Prospective Studies ; Rectal Neoplasms/pathology* ; Rectal Neoplasms/surgery
Keywords
Rectal Cancer ; Anal Verge ; Circumferential Resection Margin ; Preoperative Magnetic Resonance Imaging ; Peritoneal Reflection
Abstract
BACKGROUND: This study was designed to identify factors related to inaccurate prediction of circumferential resection margin (CRM) and the extent of mesorectal invasion (EMI) in T3 tumors by preoperative magnetic resonance imaging (MRI) in rectal cancer. METHODS: A total of 66 patients with rectal cancer were enrolled prospectively in this study. CRM was defined as the distance from the outer tumor margin to the mesorectal fascia, and EMI was defined as the distance from the outer surface of the muscularis propria to the outermost tumor margin. CRM and EMI measurements on MRI were compared with corresponding measurements from whole-mount sections using 1-mm and 5-mm reference values, respectively, as prognostic indicators. The following variables were analyzed for relevance to preoperative staging: tumor distance from the anal verge (lower and middle), tumor location (anterior and posterior), tumor (T) and nodal (N) stage, and the thickness of the perirectal fat (anterior, left, right, and posterior positions). RESULTS: MRI correctly predicted CRM status in 57 of the 66 tumors and EMI status in 51 of the 58 tumors (eight T1 tumors were excluded from EMI analysis). Univariate analysis showed that T3 stage, lymph node involvement, anterior tumor location, and thin perirectal fat thickness at the anterior portion were related to incorrect prediction of CRM. Anterior tumor location and thin perirectal fat thickness at the anterior portion were related to incorrect prediction of EMI. CONCLUSIONS: Preoperative chemoradiation can be accurately guided by preoperative MRI staging, but CRM and EMI in anterior rectal tumor should be interpreted with caution.
Full Text
http://link.springer.com/article/10.1007%2Fs00268-009-0126-z
DOI
10.1007/s00268-009-0126-z
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Kim, Young Wan(김영완)
Kim, Hogeun(김호근)
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/104584
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