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Postchemoradiation magnetic resonance imaging circumferential resection margin predicts treatment failure after multidisciplinary directed sphincter preservation in low rectal cancer

Authors
 Sun Jung Kim  ;  Yong Joon Lee  ;  Min Young Park  ;  Seung Yoon Yang  ;  Yoon Dae Han  ;  Min Soo Cho  ;  Hyuk Hur  ;  Kang Young Lee  ;  Joon Seok Lim  ;  Byung Soh Min 
Citation
 JOURNAL OF SURGICAL ONCOLOGY, Vol.128(8) : 1365-1371, 2023-12 
Journal Title
JOURNAL OF SURGICAL ONCOLOGY
ISSN
 0022-4790 
Issue Date
2023-12
MeSH
Chemoradiotherapy / methods ; Humans ; Magnetic Resonance Imaging ; Margins of Excision* ; Neoadjuvant Therapy / methods ; Neoplasm Staging ; Rectal Neoplasms* / diagnostic imaging ; Rectal Neoplasms* / surgery ; Retrospective Studies ; Treatment Failure ; Treatment Outcome
Keywords
circumferential resection margins ; magnetic resonance imaging ; neoadjuvant chemoradiotherapy ; rectal cancer ; sphincter preservation failure
Abstract
Background: This study aimed to review the magnetic resonance imaging (MRI) features of patients with low rectal cancer (LRC) undergoing preoperative chemoradiotherapy (CRT) and investigate the risk factors for treatment failure after sphincter preserving surgery following preoperative CRT based on multidisciplinary approach.Objectives: Patients who underwent standard CRT and sphincter preserving radical surgery for LRC between January 2000 and December 2011 were retrospectively reviewed. Sphincter preservation failure (SPF) was defined as any one of the following: positive pathologic circumferential resection margin, local recurrence, failure to repair ileostomy, or permanent stoma formation due to anastomotic complications.Results: Among the 191 patients, there were no overall significant differences between sphincter preservation success (n = 161) and SPF (n = 30) groups. SPF group showed a higher MRI circumferential resection margins (mrCRM) positive rate before and after CRT (before CRT: 33.3% vs. 16.1%, p = 0.027; after CRT: 23.3% vs. 6.2%, p = 0.002). Multivariate analysis showed that only mrCRM after CRT was associated with SPF (hazard ratio = 4.596, p = 0.005). SPF group showed worse 5-year cancer-specific survival (51% vs. 92.7%, p < 0.001).Conclusions: MRI-based assessment of the tumor after CRT plays a crucial role in predicting the success and feasibility of sphincter preservation as well as oncological outcomes in patients with LRC.
Full Text
https://onlinelibrary.wiley.com/doi/10.1002/jso.27449
DOI
10.1002/jso.27449
Appears in Collections:
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, Sun Jung(김선정)
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Yang, Seung Yoon(양승윤) ORCID logo https://orcid.org/0000-0001-8129-7712
Lee, Kang Young(이강영)
Lee, Yong Joon(이용준)
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
Cho, Min Soo(조민수)
Han, Yoon Dae(한윤대) ORCID logo https://orcid.org/0000-0002-2136-3578
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/197997
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