Advertisement

How Can We Identify Mesorectal Fascia Involvement?

  • Regina G. H. Beets-Tan
Chapter

Abstract

The circumferential resection margin (CRM) is the lateral or radial resection margin created by the surgeon at the total mesorectal excision. A positive CRM is defined as a closest distance of 1 mm or less between tumor and resection margin, as this represents the optimal prognostic cutoff point. The importance as a prognostic factor and as a parameter of surgical quality has been recognized and confirmed in the past 20 years [1]. Because the ideal plane of resection in a total mesorectal excision is just outside the mesorectal fascia, a relevant question in rectal cancer surgery which is addressed in this chapter is “How can we identify mesorectal fascia involvement?”

Keywords

Magnetic Resonance Imaging Rectal Cancer Circumferential Resection Margin Rectal Cancer Surgery Mesorectal Fascia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26(2):303–312PubMedCrossRefGoogle Scholar
  2. 2.
    Bissett IP, Fernando CC, Hough DM et al (2001) Identification of the fascia propria by magnetic resonance imaging and its relevance to preoperative assessment of rectal cancer. Dis Colon Rectum 44(2):259–265PubMedCrossRefGoogle Scholar
  3. 3.
    Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246(5):693–701PubMedCrossRefGoogle Scholar
  4. 4.
    Wolberink SV, Beets-Tan RG, de Haas-Kock DF et al (2009) Multislice CT as a primary screening tool for the prediction of an involved mesorectal fascia and distant metastases in primary rectal cancer: a multicenter study. Dis Colon Rectum 52(5):928–934PubMedCrossRefGoogle Scholar
  5. 5.
    Taylor A, Slater A, Mapstone N et al (2007) Staging rectal cancer: MRI compared to MDCT. Abdom Imaging 32(3):323–327PubMedCrossRefGoogle Scholar
  6. 6.
    Vliegen R, Dresen R, Beets G et al (2008) The accuracy of multi-detector row CT for the assessment of tumor invasion of the mesorectal fascia in primary rectal cancer. Abdom Imaging 33(5):604–610PubMedCrossRefGoogle Scholar
  7. 7.
    Maizlin ZV, Brown JA, So G, Brown C, Phang TP, Walker ML, Kirby JM, Vora P, Tiwari P (2010) Can CT replace MRI in preoperative assessment of the circumferential resection margin in rectal cancer? Dis Colon Rectum 53(3):308–314PubMedCrossRefGoogle Scholar
  8. 8.
    Beets-Tan RG, Beets GL, Vliegen RF et al (2001) Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet 357(9255):497–504PubMedCrossRefGoogle Scholar
  9. 9.
    Blomqvist L, Machado M, Rubio C et al (2000) Rectal tumour staging: MR imaging using pelvic phased-array and endorectal coils vs endoscopic ultrasonography. Eur Radiol 10(4):653–660PubMedCrossRefGoogle Scholar
  10. 10.
    Peschaud F, Cuenod CA, Benoist S et al (2005) Accuracy of magnetic resonance imaging in rectal cancer depends on location of the tumor. Dis Colon Rectum 48(8):1603–1609PubMedCrossRefGoogle Scholar
  11. 11.
    Lahaye MJ, Engelen SM, Nelemans PJ et al (2005) Imaging for predicting the risk factors – the circumferential resection margin and nodal disease – of local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR 26(4):259–268PubMedCrossRefGoogle Scholar
  12. 12.
    MERCURY Study Group (2006) Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer, prospective observational study. BMJ 333(7572):779CrossRefGoogle Scholar
  13. 13.
    Beets-Tan RG, Lettinga T, Beets GL (2005) Pre-operative imaging of rectal cancer and its impact on surgical performance and treatment outcome. Eur J Surg Oncol 31(6):681–688PubMedCrossRefGoogle Scholar
  14. 14.
    Burton S, Brown G, Daniels IR et al (2006) MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins? Br J Cancer 94(3):351–357PubMedCrossRefGoogle Scholar
  15. 15.
    Vliegen RF, Beets GL, Lammering G et al (2008) Mesorectal fascia invasion after neoadjuvant chemotherapy and radiation therapy for locally advanced rectal cancer: accuracy of MR imaging for prediction. Radiology 246(2):454–462PubMedCrossRefGoogle Scholar
  16. 16.
    Kulkarni T, Gollins S, Maw A et al (2008) Magnetic resonance imaging in rectal cancer downstaged using neoadjuvant chemoradiation: accuracy of prediction of tumour stage and circumferential resection margin status. Colorectal Dis 10(5):479–489, Epub 2008 Mar 3PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of RadiologyMaastricht University Medical CentreMaastrichtThe Netherlands

Personalised recommendations