Gulsen Atasoy1, Naciye Cigdem Arslan2,3, Funda Dinc Elibol4, Ozgul Sagol5, Funda Obuz4, Selman Sokmen1. 1. Department of Colorectal Surgery, Dokuz Eylul University Medical Faculty, 35340, Izmir, Turkey. 2. Department of Colorectal Surgery, Istanbul Medipol University Medical Faculty, 34320, Istanbul, Turkey. cigdemarslan@hotmail.it. 3. Department of General Surgery, Istanbul Medipol University, Esenler, 34320, Istanbul, Turkey. cigdemarslan@hotmail.it. 4. Department of Radiology, Dokuz Eylul University Medical Faculty, 35340, Izmir, Turkey. 5. Department of Pathology, Dokuz Eylul University Medical Faculty, 35340, Izmir, Turkey.
Abstract
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.
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.
Entities:
Keywords:
Local recurrence; Magnetic resonance; Pelvimetry; Rectal cancer; Survival
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