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

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Funding

None to declare.

Author information

Authors and Affiliations

  1. Department of Surgery, Campus Benjamin Franklin, Charité, University Medicine, Berlin, Germany

    Martin E. Kreis MD

  2. Department of General and Visceral Surgery, Endocrine Surgery, and Coloproctology, Municipal Hospital of Munich-Neuperlach, Munich, Germany

    Reinhard Ruppert MD

  3. Department of Surgery, Carl-Thiem-Klinik, Cottbus, Germany

    Rainer Kube MD

  4. Department of General and Visceral Surgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany

    Joachim Strassburg MD

  5. Department of General and Visceral Surgery, Sana Klinikum Lichtenberg, Berlin, Germany

    Andreas Lewin MD

  6. Department of General and Visceral Surgery, Municipal Hospital, Karlsruhe, Germany

    Joerg Baral MD

  7. Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland

    Christoph A. Maurer MD

  8. HIRSLANDEN Private Hospital Group, Clinic Beau-Site, Bern, Switzerland

    Christoph A. Maurer MD

  9. Department for General, Visceral and Minimal Invasive Surgery, Arnsberg, Germany

    Joerg Sauer MD

  10. Department for General and Visceral Surgery, Thoracic Surgery and Proctology University Medical Centre, Herford, Germany

    Günther Winde MD

  11. Department for General, Visceral and Minimal Invasive Surgery, Municipal Hospital Wolfenbüttel, Wolfenbüttel, Germany

    Rena Thomasmeyer MD

  12. Dresden-Friedrichstadt General Hospital, Dresden, Germany

    Sigmar Stelzner MD

  13. Hospital St. Elisabeth, Wittlich, Germany

    Cornelius Bambauer MD

  14. Department for General and Visceral Surgery, Evangelisches Krankenhaus Lippstadt, Lippstadt, Germany

    Soenke Scheunemann MD

  15. Department for Genera- and Visceral Surgery, Brüderkrankenhaus St. Josef Paderborn, Paderborn, Germany

    Axel Faedrich MD

  16. Department of General and Abdominal Surgery, University Medical Centre at the Johannes Gutenberg-University, Mainz, Germany

    Theodor Junginger MD

  17. Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

    Paul Hermanek MD & Susanne Merkel MD

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  1. Martin E. Kreis MD
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For the OCUM group

Corresponding author

Correspondence to Theodor Junginger MD.

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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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Kreis, M.E., Ruppert, R., Kube, R. et al. MRI-Based Use of Neoadjuvant Chemoradiotherapy in Rectal Carcinoma: Surgical Quality and Histopathological Outcome of the OCUM Trial. Ann Surg Oncol 27, 417–427 (2020). https://doi.org/10.1245/s10434-019-07696-y

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