Magnetic resonance imaging following neoadjuvant chemoradiation and transanal endoscopic microsurgery for rectal cancer

Julião, Guilherme P. São; Ortega, Cinthia D.; Vailati, Bruna Borba; Habr‐Gama, Angelita; Fernández, Laura Melina; Gama-Rodrigues, Joaquim; Araújo, Sérgio Eduardo Alonso; Perez, Rodrigo Oliva

doi:10.1111/codi.13691

Cited by 15 publications

(16 citation statements)

References 23 publications

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“…20,21 In earlier studies, the size of the lymph nodes was used as a positive indicator of lymph node metastasis; however, previous studies have demonstrated that enlarged lymph nodes do not always indicate metastasis and may result from exaggerated inflammatory response, whereas lymph nodes of normal size can also have micrometastases. 22 Therefore, the size of lymph nodes is not the standard to distinguish benign and malignant lesions. The accuracy in this study for evaluating lymph node metastasis was 50.1%.…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Size and Stage of Preoperative Tumor Defined by Preoperative Magnetic Resonance Imaging and Postoperative Specimens After Radical Resection of Esophageal Cancer

Gao

Hua

et al. 2019

Technol Cancer Res Treat

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Background: Our objective is to explore the accuracy of magnetic resonance imaging in determining the preoperative T and N staging, pathological stage, and the length of esophageal tumor in patients with esophageal cancer. Methods: This retrospective analysis included 57 patients admitted to the Department of Thoracic Surgery of The First Affiliated Hospital of Nanjing Medical University between January 2015 and December 2016. Postoperative pathological results were used as the reference to verify the accuracy of magnetic resonance imaging in evaluating tumor T and N staging, pathological stage, and tumor length. The correlation between tumor lengths—measured using magnetic resonance imaging and the surgical specimen measurements—was evaluated. Results: The mean age of the patients was 64.6 ± 7.2 years, with a range of 47 to 77 years. The overall accuracy rate of magnetic resonance imaging in T staging of esophageal cancer was 63.2%; magnetic resonance imaging was generally consistent in the N staging of esophageal cancer. Magnetic resonance imaging and surgical evaluation of tumor length were in excellent agreement (κ = .82, P < .001), while that of gastroscopy and postoperative pathology was moderate (κ = .63, P < .001). Conclusion: Magnetic resonance imaging is highly accurate in determining the preoperative T and N staging, pathologic stage, and tumor length in patients with esophageal cancer, which is important in deciding the choice of preoperative treatment and the surgical approach.

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Section: Discussionmentioning

confidence: 99%

Comparison Between Size and Stage of Preoperative Tumor Defined by Preoperative Magnetic Resonance Imaging and Postoperative Specimens After Radical Resection of Esophageal Cancer

Gao

Hua

et al. 2019

Technol Cancer Res Treat

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“…However, significant architectural changes and irregular format of these scars may be difficult to interpret during follow-up. 32 Progressive and significant increases in thickness of these scars should be indicative of possible recurrence. In this setting, baseline MR imaging scans may provide relevant information for comparison during follow-up and are strongly recommended 33 ( Fig.…”

Section: Technical Consequencesmentioning

confidence: 99%

Transanal Local Excision of Rectal Cancer after Neoadjuvant Chemoradiation: Is There a Place for It or Should Be Avoided at All Costs?

Perez

Julião

Vailati

2022

Clin Colon Rectal Surg

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Tumor response to neoadjuvant chemoradiation (nCRT) with tumor downsizing and downstaging has significantly impacted the number of patients considered to be appropriate candidates for transanal local excision (TLE). Some patients may harbor small residual lesions, restricted to the bowel wall. These patients, who exhibit major response (“near-complete”) by digital rectal examination, endoscopic assessment, and radiological assessment may be considered for this approach. Although TLE is associated with minimal postoperative morbidity, a few clinical consequences and oncological outcomes must be evaluated in advance and with caution. In the setting of nCRT, a higher risk for clinically relevant wound dehiscences leading to a considerable risk for readmission for pain management has been observed. Worse anorectal function (still better than after total mesorectal excision [TME]), worsening in the quality of TME specimen, and higher rates of abdominal resections (in cases requiring completion TME) have been reported. The exuberant scar observed in the area of TLE also represents a challenging finding during follow-up of these patients. Local excision should be probably restricted for patients with primary tumors located at or below the level of the anorectal ring (magnetic resonance defined). These patients are otherwise candidates for abdominal perineal resections or ultra-low anterior resections with coloanal anastomosis frequently requiring definitive stomas or considerably poor anorectal function.

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“…MRI may be helpful in detecting recurrences and plan radical surgical salvage resection. Local recurrence after nCRT and local excision may manifest as tumor intermediate signal intensity growing along the scar [22, 80]. Inflammatory changes may overlap tumor recurrence; therefore, serial exams might help in detecting tumor-related changes (Fig.…”

Section: Restaging After Radiotherapymentioning

confidence: 99%

Role of magnetic resonance imaging in organ-preserving strategies for the management of patients with rectal cancer

Ortega

Perez

2019

Insights Imaging

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Total mesorectal excision has been the most effective treatment strategy adopted to reduce local recurrence rates among patients with rectal cancer. The morbidity associated with this radical surgical procedure led surgeons to challenge the standard therapy particularly when dealing with superficial lesions or good responders after neoadjuvant radiotherapy, to which radical surgery may be considered overtreatment. In this subset of patients, less invasive procedures in an organ-preserving strategy may result in good oncological and functional outcomes. In order to tailor the most appropriate treatment option, accurate baseline staging and reassessment of tumor response are relevant. MRI is the most robust tool for the precise selection of patients that are candidates for organ preservation; therefore, radiologists must be familiar with the criteria used to guide the management of these patients. The purpose of this article is to review the relevant features that radiologists should know in order to provide valuable information during the multidisciplinary discussion and ultimate management decision.

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Magnetic resonance imaging following neoadjuvant chemoradiation and transanal endoscopic microsurgery for rectal cancer

Abstract: MRI shows high signal intensity and thickening of the rectal wall in recurrent disease in comparison to a low signal intensity fibrotic scar in non-recurrent disease. These findings may be useful in surveillance of these patients.

Cited by 15 publications

References 23 publications

Comparison Between Size and Stage of Preoperative Tumor Defined by Preoperative Magnetic Resonance Imaging and Postoperative Specimens After Radical Resection of Esophageal Cancer

Comparison Between Size and Stage of Preoperative Tumor Defined by Preoperative Magnetic Resonance Imaging and Postoperative Specimens After Radical Resection of Esophageal Cancer

Transanal Local Excision of Rectal Cancer after Neoadjuvant Chemoradiation: Is There a Place for It or Should Be Avoided at All Costs?

Role of magnetic resonance imaging in organ-preserving strategies for the management of patients with rectal cancer

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