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Magnetic resonance-based pelvimetry and tumor volumetry can predict surgical difficulty and oncologic outcome in locally advanced mid–low rectal cancer

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Abstract

Purpose

To investigate the impact of the pelvic dimensions and tumor volume on surgery in locally advanced rectal cancer.

Methods

Patients who underwent open surgery after neoadjuvant long-course chemoradiation for primary rectal cancer were included. The predictive value of magnetic resonance-based pelvic measurements and tumor volume on the surgical difficulty and oncologic outcome were analyzed.

Results

125 patients were included. The independent risk factors related to the circumferential resection margin status were the pT stage [odds ratio (OR) 3.64, confidence interval (CI) 1.409–7.327] and tumor volume after neoadjuvant chemoradiotherapy (OR 1.59, CI 1.018–2.767). The operative time (p = 0.014, OR 1.453) and pelvic depth (p = 0.023, OR 1.116) were independent predictive factors for anastomotic leak. The median follow-up was 72 (2–113) months. Local recurrence was seen in 17 (14.1%) patients. Anastomotic leak (OR 1.799, CI 0.978–3.277), the circumferential resection margin status (OR 3.217, CI 1.262–7.870) and the relative tumor volume rate (OR 1.260, CI 1.004–1.912) were independent prognosticators of local recurrence. The 5-year overall survival was 66.7%. The circumferential resection margin status (hazard ratio: 4.739, CI 2.276–9.317), pN stage (OR 3.267, CI 1.195–8.930) and relative tumor volume rate (OR 2.628, CI 1.042–6.631) were independent prognostic factors for the overall survival.

Conclusions

Relative dimensions of the tumor in the pelvis influence the local recurrence and overall survival rates. Magnetic resonance-based measurements can predict the difficulty of surgery and allow surgeons to consider the appropriate surgical approach.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Dokuz Eylul University Medical Faculty, 35340, Izmir, Turkey

    Gulsen Atasoy & Selman Sokmen

  2. Department of Colorectal Surgery, Istanbul Medipol University Medical Faculty, 34320, Istanbul, Turkey

    Naciye Cigdem Arslan

  3. Department of Radiology, Dokuz Eylul University Medical Faculty, 35340, Izmir, Turkey

    Funda Dinc Elibol & Funda Obuz

  4. Department of Pathology, Dokuz Eylul University Medical Faculty, 35340, Izmir, Turkey

    Ozgul Sagol

  5. Department of General Surgery, Istanbul Medipol University, Esenler, 34320, Istanbul, Turkey

    Naciye Cigdem Arslan

Authors
  1. Gulsen Atasoy
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  2. Naciye Cigdem Arslan
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  3. Funda Dinc Elibol
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  4. Ozgul Sagol
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Correspondence to Naciye Cigdem Arslan.

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Atasoy, G., Arslan, N.C., Elibol, F.D. et al. Magnetic resonance-based pelvimetry and tumor volumetry can predict surgical difficulty and oncologic outcome in locally advanced mid–low rectal cancer. Surg Today 48, 1040–1051 (2018). https://doi.org/10.1007/s00595-018-1690-3

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  • DOI: https://doi.org/10.1007/s00595-018-1690-3

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