Martin E Kreis1, Reinhard Ruppert2, Rainer Kube3, Joachim Strassburg4, Andreas Lewin5, Joerg Baral6, Christoph A Maurer7,8, Joerg Sauer9, Günther Winde10, Rena Thomasmeyer11, Sigmar Stelzner12, Cornelius Bambauer13, Soenke Scheunemann14, Axel Faedrich15, Theodor Junginger16, Paul Hermanek17, Susanne Merkel17. 1. Department of Surgery, Campus Benjamin Franklin, Charité, University Medicine, Berlin, Germany. 2. Department of General and Visceral Surgery, Endocrine Surgery, and Coloproctology, Municipal Hospital of Munich-Neuperlach, Munich, Germany. 3. Department of Surgery, Carl-Thiem-Klinik, Cottbus, Germany. 4. Department of General and Visceral Surgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany. 5. Department of General and Visceral Surgery, Sana Klinikum Lichtenberg, Berlin, Germany. 6. Department of General and Visceral Surgery, Municipal Hospital, Karlsruhe, Germany. 7. Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland. 8. HIRSLANDEN Private Hospital Group, Clinic Beau-Site, Bern, Switzerland. 9. Department for General, Visceral and Minimal Invasive Surgery, Arnsberg, Germany. 10. Department for General and Visceral Surgery, Thoracic Surgery and Proctology University Medical Centre, Herford, Germany. 11. Department for General, Visceral and Minimal Invasive Surgery, Municipal Hospital Wolfenbüttel, Wolfenbüttel, Germany. 12. Dresden-Friedrichstadt General Hospital, Dresden, Germany. 13. Hospital St. Elisabeth, Wittlich, Germany. 14. Department for General and Visceral Surgery, Evangelisches Krankenhaus Lippstadt, Lippstadt, Germany. 15. Department for Genera- and Visceral Surgery, Brüderkrankenhaus St. Josef Paderborn, Paderborn, Germany. 16. Department of General and Abdominal Surgery, University Medical Centre at the Johannes Gutenberg-University, Mainz, Germany. Junginger@uni-mainz.de. 17. Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Abstract
BACKGROUND: Preoperative magnetic resonance imaging (MRI) allows highly reliable imaging of the mesorectal fascia (mrMRF) and its relationship to the tumor. The prospective multicenter observational study OCUM uses these findings to indicate neoadjuvant chemoradiotherapy (nCRT) in rectal carcinoma. METHODS: nCRT was indicated in patients with positive mrMRF (≤ 1 mm) in cT4 and cT3 carcinomas of the lower rectal third. RESULTS: A total of 527 patients (60.2%) underwent primary total mesorectal excision, and 348 patients (39.8%) underwent long-term nCRT followed by surgery. The mrMRF was involved in 4.6% of the primary surgery group and 80.7% of the nCRT group. Rates of resections within the mesorectal plane (90.8%), sparing of pelvic nerves on both sides (97.8%), and number of regional lymph nodes (95.3% with ≥ 12 lymph nodes examined) are indicative of high-quality surgery. Resection was classified as R0 in 98.3%, the pathological circumferential resection margin (pCRM) was negative in 95.1%. Patients in the nCRT group had more advanced carcinomas with a significantly higher rate of abdominoperineal excision. Independent risk factors for pCRM positivity were advanced stage (T4), metastatic lymph nodes, resection in the muscularis propria plane, and location in the lower third. CONCLUSIONS: The risk classification of rectal cancer patients by MRI seems to be highly reliable and allows the restriction of nCRT to approximately half of the patients with clinical stage II and III rectal carcinoma, provided there is a high-quality MRI diagnostic protocol, high-quality surgery, and standardized examination of the resected specimen.
BACKGROUND: Preoperative magnetic resonance imaging (MRI) allows highly reliable imaging of the mesorectal fascia (mrMRF) and its relationship to the tumor. The prospective multicenter observational study OCUM uses these findings to indicate neoadjuvant chemoradiotherapy (nCRT) in rectal carcinoma. METHODS: nCRT was indicated in patients with positive mrMRF (≤ 1 mm) in cT4 and cT3carcinomas of the lower rectal third. RESULTS: A total of 527 patients (60.2%) underwent primary total mesorectal excision, and 348 patients (39.8%) underwent long-term nCRT followed by surgery. The mrMRF was involved in 4.6% of the primary surgery group and 80.7% of the nCRT group. Rates of resections within the mesorectal plane (90.8%), sparing of pelvic nerves on both sides (97.8%), and number of regional lymph nodes (95.3% with ≥ 12 lymph nodes examined) are indicative of high-quality surgery. Resection was classified as R0 in 98.3%, the pathological circumferential resection margin (pCRM) was negative in 95.1%. Patients in the nCRT group had more advanced carcinomas with a significantly higher rate of abdominoperineal excision. Independent risk factors for pCRM positivity were advanced stage (T4), metastatic lymph nodes, resection in the muscularis propria plane, and location in the lower third. CONCLUSIONS: The risk classification of rectal cancerpatients by MRI seems to be highly reliable and allows the restriction of nCRT to approximately half of the patients with clinical stage II and III rectal carcinoma, provided there is a high-quality MRI diagnostic protocol, high-quality surgery, and standardized examination of the resected specimen.
Authors: Qiaoyu Xu; Yanyan Xu; Hongliang Sun; Tao Jiang; Sheng Xie; Bee Yen Ooi; Yi Ding Journal: Cancer Manag Res Date: 2021-06-01 Impact factor: 3.989