G P São Julião1,2, C D Ortega1,3, B B Vailati1,2, A Habr-Gama1,2,3, L M Fernandez1, J Gama-Rodrigues1,2,3, S E Araujo4, R O Perez1,2,4,5,6. 1. Angelita and Joaquim Gama Institute, Sao Paulo, SP, Brazil. 2. Hospital Alemão Oswaldo Cruz, Sao Paulo, SP, Brazil. 3. School of Medicine, University of São Paulo, Sao Paulo, SP, Brazil. 4. Colorectal Surgery Division, School of Medicine, University of São Paulo, Sao Paulo, SP, Brazil. 5. São Paulo Branch, Ludwig Institute for Cancer Research, Sao Paulo, SP, Brazil. 6. Surgical Oncology Division, BP - A Beneficência Portuguesa de São Paulo, Sao Paulo, SP, Brazil.
Abstract
AIM: Full-thickness local excision after neoadjuvant chemoradiotherapy (CRT) for patients with rectal cancer and incomplete clinical response has been a treatment strategy for organ preservation. Follow-up of these patients is challenging since anatomic distortion and postoperative changes may be clinically indistinguishable from tumour recurrence. MRI may have a role in detecting recurrence. The aim of this study was to describe the MRI findings during follow-up in patients having local excision following CRT with and without local recurrence. METHOD: The data were collected retrospectively from a single centre. Fifty-three patients with rectal cancer who had full-thickness local excision after neoadjuvant CRT and near-complete response were eligible for the study. Patients with local recurrence were treated by radical salvage surgery. The main outcome was local MRI assessment findings during follow-up. RESULTS: Fifteen patients (five who developed local recurrence and 10 with no evidence of local recurrence) had MR images available for review and were included in the study. High signal intensity and thickening of the rectal wall were present in all patients with recurrent disease within the rectal wall. Overall, 80% of the patients with recurrence showed diffusion restriction. MRI mesorectal fascia status and circumferential resection margin showed agreement in all cases. A low signal intensity scar was seen in all patients without recurrent disease. CONCLUSION: MRI shows high signal intensity and thickening of the rectal wall in recurrent disease in comparison to a low signal intensity fibrotic scar in non-recurrent disease. These findings may be useful in surveillance of these patients. Colorectal Disease
AIM: Full-thickness local excision after neoadjuvant chemoradiotherapy (CRT) for patients with rectal cancer and incomplete clinical response has been a treatment strategy for organ preservation. Follow-up of these patients is challenging since anatomic distortion and postoperative changes may be clinically indistinguishable from tumour recurrence. MRI may have a role in detecting recurrence. The aim of this study was to describe the MRI findings during follow-up in patients having local excision following CRT with and without local recurrence. METHOD: The data were collected retrospectively from a single centre. Fifty-three patients with rectal cancer who had full-thickness local excision after neoadjuvant CRT and near-complete response were eligible for the study. Patients with local recurrence were treated by radical salvage surgery. The main outcome was local MRI assessment findings during follow-up. RESULTS: Fifteen patients (five who developed local recurrence and 10 with no evidence of local recurrence) had MR images available for review and were included in the study. High signal intensity and thickening of the rectal wall were present in all patients with recurrent disease within the rectal wall. Overall, 80% of the patients with recurrence showed diffusion restriction. MRI mesorectal fascia status and circumferential resection margin showed agreement in all cases. A low signal intensity scar was seen in all patients without recurrent disease. CONCLUSION: MRI shows high signal intensity and thickening of the rectal wall in recurrent disease in comparison to a low signal intensity fibrotic scar in non-recurrent disease. These findings may be useful in surveillance of these patients. Colorectal Disease
Authors: Guilherme Pagin São Julião; Cinthia D Ortega; Bruna Borba Vailati; Francisco A B Coutinho; Gustavo Rossi; Angelita Habr-Gama; Laura Melina Fernandez; Sérgio Eduardo Alonso Araújo; Gina Brown; Rodrigo Oliva Perez Journal: World J Surg Date: 2018-11 Impact factor: 3.352
Authors: Evie Carchman; Daniel I Chu; Gregory D Kennedy; Melanie Morris; Marc Dakermandji; John R T Monson; Laura Melina Fernandez; Rodrigo Oliva Perez; Alessandro Fichera; Marco E Allaix; David Liska Journal: J Gastrointest Surg Date: 2018-09-13 Impact factor: 3.452