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MRI-Based Use of Neoadjuvant Chemoradiotherapy in Rectal Carcinoma: Surgical Quality and Histopathological Outcome of the OCUM Trial

  • Martin E. Kreis
  • Reinhard Ruppert
  • Rainer Kube
  • Joachim Strassburg
  • Andreas Lewin
  • Joerg Baral
  • Christoph A. Maurer
  • Joerg Sauer
  • Günther Winde
  • Rena Thomasmeyer
  • Sigmar Stelzner
  • Cornelius Bambauer
  • Soenke Scheunemann
  • Axel Faedrich
  • Theodor JungingerEmail author
  • Paul Hermanek
  • Susanne Merkel
  • For the OCUM group
Colorectal Cancer
  • 24 Downloads

Abstract

Background

Preoperative magnetic resonance imaging (MRI) allows highly reliable imaging of the mesorectal fascia (mrMRF) and its relationship to the tumor. The prospective multicenter observational study OCUM uses these findings to indicate neoadjuvant chemoradiotherapy (nCRT) in rectal carcinoma.

Methods

nCRT was indicated in patients with positive mrMRF (≤ 1 mm) in cT4 and cT3 carcinomas of the lower rectal third.

Results

A total of 527 patients (60.2%) underwent primary total mesorectal excision, and 348 patients (39.8%) underwent long-term nCRT followed by surgery. The mrMRF was involved in 4.6% of the primary surgery group and 80.7% of the nCRT group. Rates of resections within the mesorectal plane (90.8%), sparing of pelvic nerves on both sides (97.8%), and number of regional lymph nodes (95.3% with ≥ 12 lymph nodes examined) are indicative of high-quality surgery. Resection was classified as R0 in 98.3%, the pathological circumferential resection margin (pCRM) was negative in 95.1%. Patients in the nCRT group had more advanced carcinomas with a significantly higher rate of abdominoperineal excision. Independent risk factors for pCRM positivity were advanced stage (T4), metastatic lymph nodes, resection in the muscularis propria plane, and location in the lower third.

Conclusions

The risk classification of rectal cancer patients by MRI seems to be highly reliable and allows the restriction of nCRT to approximately half of the patients with clinical stage II and III rectal carcinoma, provided there is a high-quality MRI diagnostic protocol, high-quality surgery, and standardized examination of the resected specimen.

Notes

Funding

None to declare.

Disclosure

Martin E. Kreis, Reinhard Ruppert, Rainer Kube, Joachim Strassburg, Andreas Lewin, Joerg Baral, Christoph A. Maurer, Joerg Sauer, Günther Winde, Rena Thomasmeyer, Sigmar Stelzner, Cornelius Bambauer, Soenke Scheunemann, Axel Faedrich, Theodor Junginger, Paul Hermanek, and Susanne Merkel have no conflicts of interest to declare.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Martin E. Kreis
    • 1
  • Reinhard Ruppert
    • 2
  • Rainer Kube
    • 3
  • Joachim Strassburg
    • 4
  • Andreas Lewin
    • 5
  • Joerg Baral
    • 6
  • Christoph A. Maurer
    • 7
    • 8
  • Joerg Sauer
    • 9
  • Günther Winde
    • 10
  • Rena Thomasmeyer
    • 11
  • Sigmar Stelzner
    • 12
  • Cornelius Bambauer
    • 13
  • Soenke Scheunemann
    • 14
  • Axel Faedrich
    • 15
  • Theodor Junginger
    • 16
    Email author
  • Paul Hermanek
    • 17
  • Susanne Merkel
    • 17
  • For the OCUM group
  1. 1.Department of Surgery, Campus Benjamin Franklin, CharitéUniversity MedicineBerlinGermany
  2. 2.Department of General and Visceral Surgery, Endocrine Surgery, and ColoproctologyMunicipal Hospital of Munich-NeuperlachMunichGermany
  3. 3.Department of SurgeryCarl-Thiem-KlinikCottbusGermany
  4. 4.Department of General and Visceral SurgeryVivantes Klinikum im FriedrichshainBerlinGermany
  5. 5.Department of General and Visceral SurgerySana Klinikum LichtenbergBerlinGermany
  6. 6.Department of General and Visceral SurgeryMunicipal HospitalKarlsruheGermany
  7. 7.Department of SurgeryCantonal Hospital BasellandLiestalSwitzerland
  8. 8.HIRSLANDEN Private Hospital Group, Clinic Beau-SiteBernSwitzerland
  9. 9.Department for General, Visceral and Minimal Invasive SurgeryArnsbergGermany
  10. 10.Department for General and Visceral Surgery, Thoracic Surgery and Proctology University Medical CentreHerfordGermany
  11. 11.Department for General, Visceral and Minimal Invasive SurgeryMunicipal Hospital WolfenbüttelWolfenbüttelGermany
  12. 12.Dresden-Friedrichstadt General HospitalDresdenGermany
  13. 13.Hospital St. ElisabethWittlichGermany
  14. 14.Department for General and Visceral SurgeryEvangelisches Krankenhaus LippstadtLippstadtGermany
  15. 15.Department for Genera- and Visceral SurgeryBrüderkrankenhaus St. Josef PaderbornPaderbornGermany
  16. 16.Department of General and Abdominal SurgeryUniversity Medical Centre at the Johannes Gutenberg-UniversityMainzGermany
  17. 17.Department of SurgeryFriedrich-Alexander-Universität Erlangen-NürnbergErlangenGermany

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