Abstract
Purpose
Very few data are available about the clinical relevance of magnetic resonance (MR) imaging in preoperative evaluation of rectal villous adenoma. The aim is to evaluate the impact of MR imaging for the surgical management of rectal villous adenoma treated by transanal endoscopic microsurgery (TEM).
Methods
All patients with histologically proven rectal villous tumours operated by TEM who had a preoperative MR imaging between 2009 and 2017 were retrospectively reviewed. All patients underwent TEM because preoperative evaluation suggested systematically usT0 or usT1 tumour. Pathological stage was blindly compared to preoperative MR imaging (location according to the anal verge and the peritoneal reflection, amount of circumferential involvement, tumour size and staging) and preoperative transrectal ultrasonography (TRUS) results.
Results
Forty-five patients were included (24 men, mean age 65 ± 8 years) with TRUS data available only in 37. Pathologic results were pT0-pTis in 32, pT1 in 10 and pT2 in 3. TRUS diagnosed correctly 36/37 lesions (97%) and understaged one pT2 tumour. A significant correlation between TRUS and pathologic results was noted (r = 0.99; p = 0.01). MR imaging diagnosed correctly 19/42 pTis-T1 and 1/3 pT2 tumours (46%). Overstaging by MR imaging was noted in 25 cases (54%). No correlation between MR imaging and pathologic results was noted (r = 0.7; p = 0.3).
Conclusion
Preoperative evaluation of rectal villous adenoma is overstaged by MRI in more than half of the patients. This study suggests that the indication of local excision by TEM for rectal villous adenoma should be based on TRUS rather than on MRI.
Similar content being viewed by others
References
De Vargas Macciucca M, Casale A, Manganaro L, Floriani I, Fiore F, Marchetti L et al (2010) Rectal villous tumours: MR features and correlation with TRUS in the preoperative evaluation. Eur J Radiol 73:329–333
Bresnihan ER, Obst D (1975) Villous adenoma of the large bowel; benign and malignant. Br J Radiol 48:801–806
Coleman HG, Loughrey MB, Murray LJ, Johnston BT, Gavin AT, Shrubsole MJ, Bhat SK, Allen PB, McConnell V, Cantwell MM (2015) Colorectal cancer risk following adenoma removal: a large prospective population-based cohort study. Cancer Epidemiol Biomark Prev 24:1373–1380
Guerrieri M, Baldarelli M, de Sanctis A, Campagnacci R, Rimini M, Lezoche E (2010) Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years' experience. Surg Endosc 24:445–449
Buess G, Kipfmuller K, Hack D, Grussner R, Heintz A, Junginger T (1988) Technique of transanal endoscopic microsurgery. Surg Endosc 2:71–75
Bretagnol F, Panis Y (2009) Management of large villous tumors of the lower part of the rectum. Gastroenterol Clin Biol 33:101–105
Darwood RJ, Wheeler JM, Borley NR (2008) Transanal endoscopic microsurgery is a safe and reliable technique even for complex rectal lesions. Br J Surg 95:915–918
Khoury W, Igov I, Issa N, Gimelfarb Y, Duek SD (2014) Transanal endoscopic microsurgery for upper rectal tumors. Surg Endosc 28:2066–2071
Morino M, Risio M, Bach S, Beets-Tan R, Bujko K, Panis Y, Quirke P, Rembacken B, Rullier E, Saito Y, Young-Fadok T, Allaix ME, European Association for Endoscopic Surgery, European Society of Coloproctology (2015) Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference. Surg Endosc 29:755–773
Bentrem DJ, Okabe S, Wong WD, Guillem JG, Weiser MR, Temple LK et al (2005) T1 adenocarcinoma of the rectum: transanal excision or radical surgery? Ann Surg 242:472–479
Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J (2004) Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology 232:773–783
Koebrugge B, Bosscha K, Jager G, Ernst M (2010) Accuracy of transrectal ultrasonography in staging rectal tumors that are clinically eligible for transanal endoscopic microsurgery. J Clin Ultrasound 38:250–253
Seman M, Bretagnol F, Guedj N, Maggiori L, Ferron M, Panis Y (2010) Transanal endoscopic microsurgery (TEM) for rectal tumor: the first French single-center experience. Gastroenterol Clin Biol 34:488–493
Beets-Tan RG, Beets GL (2011) Local staging of rectal cancer: a review of imaging. J Magn Reson Imaging 33:1012–1019
Lambregts DM, Beets-Tan RG (2013) Optimal imaging staging of rectal cancer. EJC Suppl 11:38–44
Brown G, Richards CJ, Newcombe RG, Dallimore NS, Radcliffe AG, Carey DP, Bourne MW, Williams GT (1999) Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology 211:215–222
Brown G, Richards CJ, Bourne MW, Newcombe RG, Radcliffe AG, Dallimore NS, Williams GT (2003) Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 227:371–377
Maggiori L, Panis Y (2012) Transanal endoscopic microsurgery (TEM) for T1 rectal cancer. Acta Chir Iugosl 59:87–90
Dixon MF (2002) Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 51:130–131
Kikuchi R, Takano M, Takagi K, Fujimoto N, Nozaki R, Fujiyoshi T, Uchida Y (1995) Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum 38:1286–1295
Cohen J (1968) Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70:213–220
Zou KH, Tuncali K, Silverman SG (2003) Correlation and simple linear regression. Radiology 227:617–622
Beaumont C, Pandey T, Gaines Fricke R, Laryea J, Jambhekar K (2013) MR evaluation of rectal cancer: current concepts. Curr Probl Diagn Radiol 42:99–112
Carmody BJ, Otchy DP (2000) Learning curve of transrectal ultrasound. Dis Colon Rectum 43:193–197
Ptok H, Marusch F, Meyer F, Wendling P, Wenisch HJ, Sendt W et al (2006) Feasibility and accuracy of TRUS in the pre-treatment staging for rectal carcinoma in general practice. Eur J Surg Oncol 32:420–425
Buresi MC, Zandieh I, Nagy AG, Spielmann A, Yee WC, Weiss AA, Yoshida EM (2009) The use of endoscopic ultrasonography and other imaging modalities in the preoperative staging of rectal villous tumours: a case of overstaging by magnetic resonance imaging. Can J Gastroenterol 23:639–641
Issa N, Fenig Y, Yasin M, Schmilovitz-Weiss H, Khoury W, Powsner E (2016) Laparoscopy following peritoneal entry during transanal endoscopic microsurgery may increase the safety and maximize the benefits of the transanal excision. Tech Coloproctol 20:221–226
Mege D, Petrucciani N, Maggiori L, Panis Y (2017) Peritoneal perforation is less a complication than an expected event during transanal endoscopic microsurgery: experience from 194 consecutive cases. Tech Coloproctol 21:729–736
Morino M, Allaix ME, Famiglietti F, Caldart M, Arezzo A (2013) Does peritoneal perforation affect short- and long-term outcomes after transanal endoscopic microsurgery? Surg Endosc 27:181–188
Gollub MJ, Maas M, Weiser M, Beets GL, Goodman K, Berkers L, Beets-Tan RGH (2013) Recognition of the anterior peritoneal reflection at rectal MRI. AJR Am J Roentgenol 200:97–101
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Raynaud, L., Mege, D., Zappa, M. et al. Is magnetic resonance imaging useful for the management of patients with rectal villous adenoma? A study of 45 consecutive patients treated by transanal endoscopic microsurgery. Int J Colorectal Dis 33, 1695–1701 (2018). https://doi.org/10.1007/s00384-018-3148-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-018-3148-x