Nigel D'Souza1, Amy Lord2, Annabel Shaw2, Anisha Patel3, Svetlana Balyasnikova4, Vera Tudyka5, Muti Abulafi6, Brendan Moran7, Shahnawaz Rasheed4, Paris Tekkis4, Monica Terlizzo3, Nick West8, Philip Quirke8, Gina Brown4. 1. Croydon University Hospital, UK; Royal Marsden Hospital, UK; Imperial College London, UK. Electronic address: nigel.d'souza@nhs.net. 2. Croydon University Hospital, UK; Royal Marsden Hospital, UK; Imperial College London, UK. 3. Royal Marsden Hospital, UK. 4. Royal Marsden Hospital, UK; Imperial College London, UK. 5. Kingston Hospital, UK. 6. Croydon University Hospital, UK. 7. Basingstoke Hospital, UK. 8. Pathology & Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, UK.
Abstract
BACKGROUND: A pre-operative imaging landmark to define the rectum would optimise clinical care of rectal cancer patients and research efforts to improve outcomes. The sigmoid take-off has been suggested as an imaging landmark for the rectosigmoid junction (RSJ). This study aimed to investigate whether this imaging definition of the rectum was validated by surgical specimen analysis. METHODS: This prospective study recruited 20 patients undergoing surgery and undertook radiological and pathological analysis of their rectal specimens. The radiological landmark of the sigmoid take-off was identified on pre-operative magnetic resonance imaging (MRI), and the distance to the anterior peritoneal reflection was measured by two readers. After surgery, the distance from the beginning of the sigmoid mesocolon to the anterior peritoneal reflection to the beginning of the sigmoid mesocolon on the specimen was measured, and compared to the distance on MRI using Pearson's Correlation Coefficient and Bland-Altman plots. RESULTS: In 17 patients, the mean distance from the anterior peritoneal reflection to the RSJ on MRI was 20.3 mm and 23.1 mm for two readers, and on pathology was 20.6 mm. The mean differences between MRI and specimen measurements were -0.31 mm (-2.83 to 2.20 mm), and 2.51 mm (95% confidence interval -0.31 to 5.33 mm) for each reader, with correlation coefficients of 0.77 and 0.81. CONCLUSION: The sigmoid take-off has been validated on specimen analysis to be an imaging landmark that defines the termination of the rectum. This anatomical landmark can be used to classify tumours and guide treatment and research of sigmoid colon and rectal cancer. Crown
BACKGROUND: A pre-operative imaging landmark to define the rectum would optimise clinical care of rectal cancerpatients and research efforts to improve outcomes. The sigmoid take-off has been suggested as an imaging landmark for the rectosigmoid junction (RSJ). This study aimed to investigate whether this imaging definition of the rectum was validated by surgical specimen analysis. METHODS: This prospective study recruited 20 patients undergoing surgery and undertook radiological and pathological analysis of their rectal specimens. The radiological landmark of the sigmoid take-off was identified on pre-operative magnetic resonance imaging (MRI), and the distance to the anterior peritoneal reflection was measured by two readers. After surgery, the distance from the beginning of the sigmoid mesocolon to the anterior peritoneal reflection to the beginning of the sigmoid mesocolon on the specimen was measured, and compared to the distance on MRI using Pearson's Correlation Coefficient and Bland-Altman plots. RESULTS: In 17 patients, the mean distance from the anterior peritoneal reflection to the RSJ on MRI was 20.3 mm and 23.1 mm for two readers, and on pathology was 20.6 mm. The mean differences between MRI and specimen measurements were -0.31 mm (-2.83 to 2.20 mm), and 2.51 mm (95% confidence interval -0.31 to 5.33 mm) for each reader, with correlation coefficients of 0.77 and 0.81. CONCLUSION: The sigmoid take-off has been validated on specimen analysis to be an imaging landmark that defines the termination of the rectum. This anatomical landmark can be used to classify tumours and guide treatment and research of sigmoid colon and rectal cancer. Crown
Authors: Zaid Al-Difaie; Nariaki Okamoto; Max H M C Scheepers; Didier Mutter; Laurents P S Stassen; Nicole D Bouvy; Jacques Marescaux; Bernard Dallemagne; Michele Diana; Mahdi Al-Taher Journal: Surg Endosc Date: 2022-10-18 Impact factor: 3.453