PURPOSE: The management of rectal cancer relies on accurate MRI staging. Multi-modal treatments can downstage rectal cancer prior to surgery and may have an effect on MRI accuracy. We aim to correlate the findings of MRI staging of rectal cancer with histological analysis, the effect of neoadjuvant therapy on this and the implications of circumferential resection margin (CRM) positivity following neoadjuvant therapy. METHODS: An analysis of histological data and radiological staging of all cases of rectal cancer in a single centre between 2006 and 2011 were conducted. RESULTS: Two hundred forty-one patients had histologically proved rectal cancer during the study period. One hundred eighty-two patients underwent resection. Median age was 66.6 years, and male to female ratio was 13:5. R1 resection rate was 11.1%. MRI assessments of the circumferential resection margin in patients without neoadjuvant radiotherapy were 93.6 and 88.1% in patients who underwent neoadjuvant radiotherapy. Eighteen patients had predicted positive margins following chemoradiotherapy, of which 38.9% had an involved CRM on histological analysis. CONCLUSIONS: MRI assessment of the circumferential resection margin in rectal cancer is associated with high accuracy. Neoadjuvant chemoradiotherapy has a detrimental effect on this accuracy, although accuracy remains high. In the presence of persistently predicted positive margins, complete resection remains achievable but may necessitate a more radical approach to resection.
PURPOSE: The management of rectal cancer relies on accurate MRI staging. Multi-modal treatments can downstage rectal cancer prior to surgery and may have an effect on MRI accuracy. We aim to correlate the findings of MRI staging of rectal cancer with histological analysis, the effect of neoadjuvant therapy on this and the implications of circumferential resection margin (CRM) positivity following neoadjuvant therapy. METHODS: An analysis of histological data and radiological staging of all cases of rectal cancer in a single centre between 2006 and 2011 were conducted. RESULTS: Two hundred forty-one patients had histologically proved rectal cancer during the study period. One hundred eighty-two patients underwent resection. Median age was 66.6 years, and male to female ratio was 13:5. R1 resection rate was 11.1%. MRI assessments of the circumferential resection margin in patients without neoadjuvant radiotherapy were 93.6 and 88.1% in patients who underwent neoadjuvant radiotherapy. Eighteen patients had predicted positive margins following chemoradiotherapy, of which 38.9% had an involved CRM on histological analysis. CONCLUSIONS: MRI assessment of the circumferential resection margin in rectal cancer is associated with high accuracy. Neoadjuvant chemoradiotherapy has a detrimental effect on this accuracy, although accuracy remains high. In the presence of persistently predicted positive margins, complete resection remains achievable but may necessitate a more radical approach to resection.
Authors: E Kapiteijn; C A Marijnen; I D Nagtegaal; H Putter; W H Steup; T Wiggers; H J Rutten; L Pahlman; B Glimelius; J H van Krieken; J W Leer; C J van de Velde Journal: N Engl J Med Date: 2001-08-30 Impact factor: 91.245
Authors: Atthaphorn Trakarnsanga; Mithat Gonen; Jinru Shia; Karyn A Goodman; Garrett M Nash; Larissa K Temple; José G Guillem; Philip B Paty; Julio Garcia-Aguilar; Martin R Weiser Journal: Ann Surg Oncol Date: 2013-01-18 Impact factor: 5.344
Authors: Koen C M J Peeters; Corrie A M Marijnen; Iris D Nagtegaal; Elma Klein Kranenbarg; Hein Putter; Theo Wiggers; Harm Rutten; Lars Pahlman; Bengt Glimelius; Jan Willem Leer; Cornelis J H van de Velde Journal: Ann Surg Date: 2007-11 Impact factor: 12.969
Authors: Roy F A Vliegen; Geerard L Beets; Guido Lammering; Raphaëla C Dresen; Harm J Rutten; Alfons G Kessels; Toen-Khiam Oei; Adriaan P de Bruïne; Jos M A van Engelshoven; Regina G H Beets-Tan Journal: Radiology Date: 2008-02 Impact factor: 11.105
Authors: N M Ormsby; H N Bermingham; H M Joshi; M Chadwick; A Samad; D Maitra; M Scott; S Kelly; K Whitmarsh; R Rajaganeshan Journal: Int J Colorectal Dis Date: 2016-10-01 Impact factor: 2.571