Lorenzo Liñán Miguel Ángel, García Armengol Juan, Martín Martín Gonzalo Pablo, Martínez Sanjuán Vicente, Roig Vila José Vicente
Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, , Almería, España; La filiación de Miguel Ángel Lorenzo Liñán, Juan García Armengol, Gonzalo Pablo Martin Martin y José Vicente Roig Vila en el momento de la realización de este artículo era: Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España.
Centro Europeo de Cirugía Colorrectal, Hospital Vithas Valencia 9 de Octubre, Valencia, España; La filiación de Miguel Ángel Lorenzo Liñán, Juan García Armengol, Gonzalo Pablo Martin Martin y José Vicente Roig Vila en el momento de la realización de este artículo era: Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España.
Cir Esp (Engl Ed). 2021 Sep 4. doi: 10.1016/j.ciresp.2021.07.004.
Distance from anal verge of rectal tumors and their anatomical relationships contribute to determine the multidisciplinary therapeutic strategy based on the combination of radio-chemotherapy and radical surgery. Our aims are to investigate which is the most accurate method for the preoperative measuring of the distance from the anal verge in rectal tumors and if the pelvic MRI can substitute the classical instrumental methods.
Prospective study of diagnostic precision between flexible colonoscopy (FC), preoperative rigid rectosigmoidoscopy (pRR) and pelvic MRI in patients scheduled to radical surgery. Rigid intraoperative rectoscopy (iRR) was considered the reference test. The correlations between the different techniques and their determination coefficient as well as the intraclass correlation coefficient and the degree of agreement between the different tests were analyzed.
96 patients (65% males), mean age (SD): 68 (14.1) years were included. 72% received neoadjuvant treatment. The mean distance to the anal margin measured by FC=103.5mm, was significantly greater than others, which had similar values: pRR=81.1; MRI=77.4; iRR=82.9mm (P<.001). A significant intraclass correlation was observed and there was high agreement between all pre- and intraoperative measurements except for the performed by FC, which overestimated the results. MRI provided more individualized and accurate information.
There is variability between the measurement methods, being colonoscopy the least reliable. MRI offers objective, comparable, accurate and individualized values that can replace those obtained by pRR for tumors of any location in the rectum.
直肠肿瘤距肛缘的距离及其解剖关系有助于确定基于放化疗与根治性手术相结合的多学科治疗策略。我们的目的是研究哪种方法是术前测量直肠肿瘤距肛缘距离的最准确方法，以及盆腔磁共振成像（MRI）是否可以替代传统的器械检查方法。
对计划进行根治性手术的患者，前瞻性研究柔性结肠镜检查（FC）、术前硬式直肠乙状结肠镜检查（pRR）和盆腔MRI的诊断准确性。术中硬式直肠镜检查（iRR）被视为参考检查。分析了不同技术之间的相关性及其决定系数，以及组内相关系数和不同检查之间的一致性程度。
纳入96例患者（65%为男性），平均年龄（标准差）：68（14.1）岁。72%接受了新辅助治疗。FC测量的距肛缘平均距离为103.5mm，显著大于其他方法，其他方法的值相近：pRR = 81.1；MRI = 77.4；iRR = 82.9mm（P <.001）。观察到显著的组内相关性，除FC检查结果高估外，所有术前和术中测量之间具有高度一致性。MRI提供了更个体化和准确的信息。
测量方法之间存在差异，结肠镜检查最不可靠。MRI提供了客观、可比、准确和个体化的值，可替代pRR对直肠任何部位肿瘤所获得的值。
