Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, Almería, Spain; Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
Centro Europeo de Cirugía Colorrectal, Hospital Vithas Valencia 9 de Octubre, Valencia, Spain; Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
Cir Esp (Engl Ed). 2022 Dec;100(12):772-779. doi: 10.1016/j.cireng.2022.08.015. Epub 2022 Sep 2.
Distance from anal verge of rectal tumours 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 tumours 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 = 103.5 mm, was significantly greater than others, which had similar values: pRR = 81.1; MRI = 77.4; iRR = 82.9 mm (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 tumours of any location in the rectum.
直肠肿瘤距肛门的距离及其解剖关系有助于确定基于放化疗联合根治性手术的多学科治疗策略。我们的目的是研究哪种方法是直肠肿瘤术前测量肛门距离最准确的方法，以及盆腔 MRI 是否可以替代传统的仪器方法。
对计划接受根治性手术的患者进行前瞻性诊断准确性研究，比较柔性结肠镜（FC）、术前刚性乙状结肠镜（pRR）和盆腔 MRI。刚性术中直肠镜（iRR）被认为是参考测试。分析了不同技术之间的相关性及其决定系数、组内相关系数以及不同测试之间的一致性程度。
共纳入 96 例（65%为男性），平均年龄（标准差）为 68（14.1）岁。72%的患者接受了新辅助治疗。FC 测量的距肛门边缘的平均距离为 103.5mm，明显大于其他方法，而其他方法的测量值相似：pRR=81.1mm、MRI=77.4mm、iRR=82.9mm（P<.001）。观察到显著的组内相关，并且所有术前和术中测量之间具有高度一致性，除了 FC 外，FC 高估了结果。MRI 提供了更个体化和准确的信息。
测量方法之间存在差异，结肠镜是最不可靠的方法。MRI 提供了客观、可比、准确和个体化的数值，可以替代 pRR 用于直肠任何部位的肿瘤。
