Extent and completeness of mesorectal excision evaluated by postoperative magnetic resonance imaging

Bondeven, P.; Hagemann‐Madsen, Rikke; Laurberg, Søren; Pedersen, Birthe D.

doi:10.1002/bjs.9225

Cited by 60 publications

(54 citation statements)

References 20 publications

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“…Of those patients, 134 patients did not have a postoperative MRI performed (exclusion described elsewhere 19 ). Seventy-five patients who had an MRI were not assessed for bowel dysfunction using the LARS score, either due to no clinical follow-up or because of a non-reversed stoma.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Neoadjuvant therapy abolishes the functional benefits of a larger rectal remnant, as measured by magnetic resonance imaging after restorative rectal cancer surgery

Bondeven

Emmertsen

Laurberg

et al. 2015

European Journal of Surgical Oncology (EJSO)

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Section: Resultsmentioning

confidence: 99%

“…19 In addition, patients who had undergone restorative sphincter-preserving surgery had their bowel function assessed using the LARS score 20 a minimum of one year following surgery, and when applicable, a minimum of six months following ileostomy reversal.…”

Section: Methodsmentioning

confidence: 99%

Neoadjuvant therapy abolishes the functional benefits of a larger rectal remnant, as measured by magnetic resonance imaging after restorative rectal cancer surgery

Bondeven

Emmertsen

Laurberg

et al. 2015

European Journal of Surgical Oncology (EJSO)

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“…Bondeven et al [10] reported residual mesorectum in 36% of patients who, based on the size of the tumour, should have had a TME. However, the majority of these patients underwent open TME.…”

Section: Discussionmentioning

confidence: 99%

“…However, the laparoscopic approach for middle and lower rectum cancer is still a challenge even for experienced surgeons, especially in obese male patients [9]. Furthermore, Bondeven et al [10] demonstrated that residual mesorectum is present in 36% of patients who underwent open as well as laparoscopic surgery. Thus, a new kind of minimally invasive surgical procedure, i.e.…”

Section: Introductionmentioning

confidence: 99%

Transanal Total Mesorectal Excision: Is There a Real Advantage? The Baltic View

et al. 2019

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Background: The novel surgical procedure transanal total mesorectal excision (taTME) has rapidly become an interest of research in order to overcome the shortcomings of laparoscopic surgery in the treatment of middle and low rectal cancer. taTME is a new natural orifice transluminal endoscopic surgery modality combining three rectal surgery techniques. Methods: A retrospective clinical study was conducted in a single centre for a period of 3 years, and herein we report on our first 25 taTME procedures in patients with middle and lower third rectal adenocarcinoma. Results: The main demographics were evaluated. The mean age of patients was 64 ± 12 years. There were predominantly males (72%) and 7 female patients (28%) with an average body mass index of 29 ± 4.8 kg/m². High blood pressure, obesity, chronic heart insufficiency, chronic atrial fibrillation, and diabetes mellitus were commonly diagnosed in all patients. A circumferential resection margin >1 mm was achieved in 16% (n = 4), >2 mm in 40% (n = 10), and >3 mm in 44% (n = 11) of operated patients. The average CRM was 1.8 ± 0.9 cm. In 24% of cases, the distance of a tumour from the mesorectal fascia (MRF) was <1 mm; meanwhile, for 76% of patients, the tumour margin was >1 mm from the MRF. Recovery to flatus was 3 ± 1 days. The average length of hospital stay was 11 ± 3 days. The overall postoperative morbidity was 8%, i.e. one (4%) complication classified as Clavien-Dindo degree I and one (4%) major (IIIb) complication. Subsequently, all patients successfully recovered and were discharged from hospital. During the follow-up period no cancer recurrence was observed. Conclusion: Our results nicely demonstrate that taTME can be safely performed with acceptable perioperative complications in patients with middle or lower third rectal cancer. In addition, the perioperative morbidity is also acceptable. However, taTME remains a technically highly demanding operation but is feasible and safe after the appropriate experience is gained. Nevertheless, larger multi-centre prospective randomised studies are ongoing to confirm the safety and to verify oncological results when compared to laparoscopic rectal surgery.

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“…15 The majority of LRs historically reflected inadequate mesorectal resection, 16 which is a common finding on postoperative MRI after partial mesorectal excision. 17 Currently, optimal quality-controlled surgery, in terms of TME in the trial setting, can be associated with LR rates of less than 10 %, whether patients receive RT or not. 7 Factors that compromise the performance of good-quality TME are well recognised and include patient-and disease-related aspects and the surgeon's case volume.…”

mentioning

confidence: 99%

How to Select for Preoperative Short-course Radiotherapy, While Considering Long-course Chemoradiotherapy or Immediate Surgery, and Who Benefits?

Glynne-Jones¹,

Dt²,

Moran³

et al. 2014

European Oncology &Amp; Haematology

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The management of patients with locally advanced rectal cancer (LARC) has evolved with the aim of reducing local recurrence and improving survival. Current practice has developed from refinements in surgical technique, the availability of different types of preoperative imaging, the selective or blanket use of neoadjuvant treatment (usually radiation) and sophisticated efforts exploring multimodality treatments to achieve organ preservation. Both short-course preoperative radiotherapy (SCPRT) and long-course chemoradiation (CRT) are considered standard neoadjuvant strategies, which are advocated in different parts of the world. New techniques in the delivery of radiotherapy, such as intensity-modulated radiotherapy (IMRT), may allow more precise dosing to the target volume (tumour and/or locoregional lymph nodes) and limit radiation doses to critical normal structures; however, current schedules of SCPRT and CRT impact on late function, and if they do not improve survival in resectable cancers, can they be omitted in selected cases? KeywordsRectal adenocarcinoma, neoadjuvant radiation, chemoradiation, chemotherapy, short-course preoperative radiation, long-course chemoradiation Disclosure: Rob Glynne-Jones has received honoraria for lectures and advisory boards and has been supported in attending international meetings in the last five years by Eli Lilly, Merck, Pfizer, Sanofi-Aventis and Roche. He has received unrestricted grants for research from Merck-Serono, Sanofi-Aventis and Roche. He is principal investigator of a randomised phase II neoadjuvant chemotherapy study in the UK called BACCHUS. David Tan In patients with locally advanced rectal cancer (LARC), not involving the mesorectal fascia (MRF), surgery with total mesorectal excision (TME) is the standard of care. Prior to the TME era, high rates of local recurrence (LR) were observed after radical surgery, and 10-40 % of patients required a permanent stoma, even for tumours arising in the mid/upper rectum. In the 1990s, randomised trials 1-3 established shortcourse preoperative pelvic radiotherapy (SCPRT) using 5 x 5 Gy as a component of the curative treatment of resectable and early rectal cancers. These historical trials reported LR rates of 20-30 % after surgery alone, reflecting the suboptimal surgical practice at the time.Two subsequent trials examined whether SCPRT simply compensated for poor surgical technique, i.e. whether SCPRT still reduced LR if TME was performed. By then, it was recognised that the risk of LR, after a potentially curative resection, is mainly explained by microscopic tumour cells within 1 mm of the circumferential resection margin (CRM). 4 Hence, in the control group in the event of a histopathological involved CRM, postoperative RT or chemoradiotherapy was intended in the Dutch TME study 5 and CR07 trial,6 respectively. Both trials confirmed a reduction in LR, but overall survival (OS) was not improved, and the risk of metastases predominated over LR. [5][6][7][8] During the same period, the strategy of postoperativ...

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Extent and completeness of mesorectal excision evaluated by postoperative magnetic resonance imaging

Abstract: Inadvertent residual mesorectum was commonly found on postoperative MRI, especially after partial mesorectal excision.

Cited by 60 publications

References 20 publications

Neoadjuvant therapy abolishes the functional benefits of a larger rectal remnant, as measured by magnetic resonance imaging after restorative rectal cancer surgery

Neoadjuvant therapy abolishes the functional benefits of a larger rectal remnant, as measured by magnetic resonance imaging after restorative rectal cancer surgery

Transanal Total Mesorectal Excision: Is There a Real Advantage? The Baltic View

How to Select for Preoperative Short-course Radiotherapy, While Considering Long-course Chemoradiotherapy or Immediate Surgery, and Who Benefits?

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