Murad-Regadas Sthela M, Regadas Francisco Sergio P, Rodrigues Lusmar V, Barreto Rosilma G L, Monteiro Francisco Coracy C, Landim Beethoven B, Holanda Erico C
Department of Surgery, School of Medicine of the Federal University of Ceara, Av Pontes Vieira, 2551, Fortaleza, Ceará, 60130-241, Brazil.
Surg Endosc. 2009 Jun;23(6):1286-91. doi: 10.1007/s00464-008-0150-3. Epub 2008 Sep 24.
Three-dimensional anorectal ultrasound (3-DAUS) scanning provides accurate information on tumor size and its relation to the anal muscles. The purpose of this study was to evaluate the ability of 3-DAUS to assess response to radiochemotherapy (RCT) for rectal cancer by comparing 3-DAUS images to pathological findings.
Twenty-five patients (mean age 52.4 years), staged as T2 (n = 3), T3 (n = 16) or T4 (n = 6), with lymph node metastases in 12 cases, were submitted to neoadjuvant RCT, followed by a second 3-DAUS scan 7 weeks later. The patients were grouped according to the distance (cm) between the distal tumor edge and the proximal border of the internal anal sphincter (IAS) (group I, presenting anal canal invasion; group II, < or =2.0 cm; group III, >2.0 cm). All patients were operated on and the pathological findings were compared to post-RCT 3-DAUS scanning results.
Four (16%) patients (three in group I, one in group II) experienced complete tumor regression. Fourteen (56%) tumors (six in group I, seven in group II, and one in group III) regressed partially. Distance to the IAS was >2.0 cm in eight patients (seven in group II and one in group III). The remaining six (24%) patients (all group I) experienced no regression. 3-DAUS and pathological findings were concordant in 24 (96%) patients, with only one (4%) nonconclusive post-RCT 3-DAUS result found to be a residual tumor. Tumor regression made sphincter-saving surgery possible in 13 patients (eight in group III, four complete tumor regression, and one nonconclusive on 3-DAUS). Pathological examination revealed free distal margins in all cases. The index of agreement between lymph node metastases on post-RCT 3-DAUS and surgical specimens was moderate (84%).
3-DAUS can aid significantly in the choice of surgical approach following RCT. However, a greater sample of patients is required to establish sufficiently accurate post-RCT 3-DAUS parameters.
三维肛管直肠超声（3-DAUS）扫描可提供有关肿瘤大小及其与肛门肌肉关系的准确信息。本研究的目的是通过将3-DAUS图像与病理结果进行比较，评估3-DAUS评估直肠癌放化疗（RCT）疗效的能力。
25例患者（平均年龄52.4岁），分期为T2（n = 3）、T3（n = 16）或T4（n = 6），其中12例有淋巴结转移，接受新辅助RCT，7周后进行第二次3-DAUS扫描。根据肿瘤远端边缘与肛门内括约肌（IAS）近端边界之间的距离（cm）对患者进行分组（I组，存在肛管侵犯；II组，≤2.0 cm；III组，>2.0 cm）。所有患者均接受手术治疗，并将病理结果与RCT后3-DAUS扫描结果进行比较。
4例（16%）患者（I组3例，II组1例）肿瘤完全消退。14例（56%）肿瘤（I组6例，II组7例，III组1例）部分消退。8例患者（II组7例，III组1例）距IAS的距离>2.0 cm。其余6例（24%）患者（均为I组）无消退。24例（96%）患者的3-DAUS与病理结果一致，RCT后3-DAUS结果仅1例（4%）不确定为残留肿瘤。13例患者（III组8例，4例肿瘤完全消退，3-DAUS结果1例不确定）因肿瘤消退可行保留括约肌手术。病理检查显示所有病例远端切缘阴性。RCT后3-DAUS与手术标本上淋巴结转移的一致性指数为中等（84%）。
3-DAUS可显著有助于RCT后手术方式的选择。然而，需要更大样本量的患者来建立足够准确的RCT后3-DAUS参数。
