Magnetic resonance-based pelvimetry and tumor volumetry can predict surgical difficulty and oncologic outcome in locally advanced mid-low rectal cancer.

Autor: Atasoy G; Department of Colorectal Surgery, Dokuz Eylul University Medical Faculty, 35340, Izmir, Turkey., Arslan NC; Department of Colorectal Surgery, Istanbul Medipol University Medical Faculty, 34320, Istanbul, Turkey. cigdemarslan@hotmail.it.; Department of General Surgery, Istanbul Medipol University, Esenler, 34320, Istanbul, Turkey. cigdemarslan@hotmail.it., Elibol FD; Department of Radiology, Dokuz Eylul University Medical Faculty, 35340, Izmir, Turkey., Sagol O; Department of Pathology, Dokuz Eylul University Medical Faculty, 35340, Izmir, Turkey., Obuz F; Department of Radiology, Dokuz Eylul University Medical Faculty, 35340, Izmir, Turkey., Sokmen S; Department of Colorectal Surgery, Dokuz Eylul University Medical Faculty, 35340, Izmir, Turkey.
Jazyk: angličtina
Zdroj: Surgery today [Surg Today] 2018 Dec; Vol. 48 (12), pp. 1040-1051. Date of Electronic Publication: 2018 Jun 30.
DOI: 10.1007/s00595-018-1690-3
Abstrakt: Purpose: To investigate the impact of the pelvic dimensions and tumor volume on surgery in locally advanced rectal cancer.
Methods: Patients who underwent open surgery after neoadjuvant long-course chemoradiation for primary rectal cancer were included. The predictive value of magnetic resonance-based pelvic measurements and tumor volume on the surgical difficulty and oncologic outcome were analyzed.
Results: 125 patients were included. The independent risk factors related to the circumferential resection margin status were the pT stage [odds ratio (OR) 3.64, confidence interval (CI) 1.409-7.327] and tumor volume after neoadjuvant chemoradiotherapy (OR 1.59, CI 1.018-2.767). The operative time (p = 0.014, OR 1.453) and pelvic depth (p = 0.023, OR 1.116) were independent predictive factors for anastomotic leak. The median follow-up was 72 (2-113) months. Local recurrence was seen in 17 (14.1%) patients. Anastomotic leak (OR 1.799, CI 0.978-3.277), the circumferential resection margin status (OR 3.217, CI 1.262-7.870) and the relative tumor volume rate (OR 1.260, CI 1.004-1.912) were independent prognosticators of local recurrence. The 5-year overall survival was 66.7%. The circumferential resection margin status (hazard ratio: 4.739, CI 2.276-9.317), pN stage (OR 3.267, CI 1.195-8.930) and relative tumor volume rate (OR 2.628, CI 1.042-6.631) were independent prognostic factors for the overall survival.
Conclusions: Relative dimensions of the tumor in the pelvis influence the local recurrence and overall survival rates. Magnetic resonance-based measurements can predict the difficulty of surgery and allow surgeons to consider the appropriate surgical approach.
Databáze: MEDLINE
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