Clinical Research Papers:

Predictors of surgical outcomes and survival in rectal cancer patients undergoing laparoscopic total mesorectal excision after neoadjuvant chemoradiation therapy: the interest of pelvimetry and restaging magnetic resonance imaging studies

Nicola de’Angelis _, Frederic Pigneur, Aleix Martínez-Pérez, Giulio Cesare Vitali, Filippo Landi, Teresa Torres-Sánchez, Victor Rodrigues, Riccardo Memeo, Giorgio Bianchi, Francesco Brunetti, Eloy Espin, Frederic Ris, Alain Luciani and on behalf of the EuMaRCS Study Group

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Oncotarget. 2018; 9:25315-25331. https://doi.org/10.18632/oncotarget.25431

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Nicola de’Angelis1, Frederic Pigneur2, Aleix Martínez-Pérez3, Giulio Cesare Vitali4, Filippo Landi5, Teresa Torres-Sánchez3, Victor Rodrigues5, Riccardo Memeo1, Giorgio Bianchi1, Francesco Brunetti1, Eloy Espin5, Frederic Ris4 and Alain Luciani2, on behalf of the EuMaRCS Study Group

1Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France

2Department of Radiology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France

3Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain

4Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland

5Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d’Hebron, Barcelona, Spain

Correspondence to:

Nicola de’Angelis, email: [email protected]

Keywords: rectal cancer; laparoscopic surgery; total mesorectal excision; magnetic resonance imaging; pelvimetry

Received: March 24, 2018     Accepted: April 28, 2018     Published: May 18, 2018


Background: Locally advanced rectal cancer (LARC) requires a multimodal therapy tailored to the patient and tumor characteristics. Pretreatment magnetic resonance imaging (MRI) is necessary to stage the primary tumor, while restaging MRI, which is not systematically performed, may be of interest to identify poor responders to neoadjuvant chemoradiation therapy (NCRT), and redefine therapeutic approach. The EuMaRCS study group aimed to investigate the role and accuracy of pretreatment (including pelvimetry) and restaging MRIs in predicting surgical difficulties and surgical outcomes in LARC therapy.

Methods: Patients with mid or low LARC who were administered NCRT, who underwent laparoscopic total mesorectal excision, and for whom pretreatment and restaging MRIs were available, were included.

Results: MRIs of 170 patients (median age: 61 years) were reanalyzed by the same radiologist. Pelvimetry differed significantly between males and females, but no gender difference was noted in the clinical and tumor characteristics. Tumor volume and tumor height assessed on the restaging MRI were associated, respectively, with operative time and estimated blood loss. Conversion was predicted by tumor volume, interischial distance and pubic tubercle height. The quality of the surgical resection was found to be a predictor of overall and disease-free survival. The sensitivity and specificity of tumor regression grade 1 to identify a pathologic complete response were 76.9% and 89.3%, respectively.

Conclusions: In LARC management, pelvimetry and restaging MRI may be useful to predict surgical difficulties and surgical outcomes. However, the main independent predictor of patient survival appears to be the achievement of a successful surgical resection.

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