Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt. Electronic address: https://twitter.com/dr_samehhany81.
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. Electronic address: https://twitter.com/nirhoresh.
Surgery. 2022 Oct;172(4):1085-1092. doi: 10.1016/j.surg.2022.06.005. Epub 2022 Aug 13.
Circumferential resection margin is an important prognosticator for total mesorectal excision outcome. We investigated the status of mesorectal fascia on magnetic resonance imaging compared with circumferential resection margin on pathology and factors associated with status change.
This was a retrospective analysis of a prospective database of rectal cancer patients who underwent surgery. Mesorectal fascia status on magnetic resonance imaging done before neoadjuvant therapy and circumferential resection margin status on pathology were compared. The study outcomes were factors associated with a margin status conversion between magnetic resonance imaging and pathology, and predictors of involved circumferential resection margin.
In total, 244 patients (average follow-up of 25.4 months) were included. Eighty-one (33.2%) patients had potentially involved mesorectal fascia in magnetic resonance imaging and 12 (4.9%) had involved circumferential resection margin in pathology. A total of 2.8% of patients had a conversion of clear mesorectal fascia in magnetic resonance imaging to involved circumferential resection margin. Abdominoperineal resection was significantly associated with this status change (odds ratio: 25, 95% confidence interval: 2.4-255.8, P = .007). In total, 7.4% of patients with potentially involved mesorectal fascia had persistently involved circumferential resection margin. Lack of total neoadjuvant therapy was associated with higher, yet statistically insignificant, odds of persistently involved circumferential resection margin (odds ratio: 12, 95% confidence interval: 0.65-220.8, P = .09). The significant independent predictors of involved circumferential resection margin were body mass index (odds ratio: 1.2, P = .016) and abdominoperineal resection (odds ratio: 4.22, P = .04).
Change of clear mesorectal fascia in magnetic resonance imaging to an involved circumferential resection margin in pathology was recorded in 2.8% of patients; abdominoperineal resection might be associated with this change. Approximately 7% of patients had persistent involvement of circumferential resection margin as determined by pathology. Omission of total neoadjuvant therapy might be associated with persistent margin involvement.
环周切缘是全直肠系膜切除术结果的重要预后因素。我们研究了磁共振成像上中直肠筋膜的状态与病理上的环周切缘，并分析了与状态变化相关的因素。
这是对接受手术的直肠癌患者前瞻性数据库的回顾性分析。比较了新辅助治疗前磁共振成像上中直肠筋膜的状态和病理上的环周切缘状态。研究结果是磁共振成像和病理之间切缘状态转换的相关因素，以及环周切缘受累的预测因素。
共纳入 244 例患者（平均随访 25.4 个月）。81 例（33.2%）患者磁共振成像上中直肠筋膜有潜在受累，12 例（4.9%）患者病理上有环周切缘受累。磁共振成像上清晰的中直肠筋膜转变为环周切缘受累的总发生率为 2.8%。腹会阴切除术与这种状态变化显著相关（优势比：25，95%置信区间：2.4-255.8，P=0.007）。共有 7.4%潜在受累的中直肠筋膜患者持续存在环周切缘受累。缺乏全新辅助治疗与持续环周切缘受累的可能性更高相关，但统计学上无显著意义（优势比：12，95%置信区间：0.65-220.8，P=0.09）。环周切缘受累的显著独立预测因素为体重指数（优势比：1.2，P=0.016）和腹会阴切除术（优势比：4.22，P=0.04）。
磁共振成像中环周切缘受累中直肠筋膜的变化在病理上记录为 2.8%的患者；腹会阴切除术可能与此变化有关。大约 7%的患者病理上持续存在环周切缘受累。全新辅助治疗的遗漏可能与持续的边缘受累有关。
