Preoperative staging of rectal cancer

Kwok, Henry; Bissett, Ian P.; Hill, Graham L.

doi:10.1007/s003840050002

Cited by 338 publications

(210 citation statements)

References 68 publications

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“…Their accuracy was comparable to ours. But in a metaanalysis by Kwok et al [10], the accuracy of TRUS in detecting rectal wall penetration was 87 %. Their stagespecific accuracy was.…”

Section: Discussionmentioning

confidence: 97%

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Preoperative Radiotherapy in Carcinoma Rectum

Ramakrishnaiah

Thomas

Elangovan

et al. 2012

Indian J Surg Oncol

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The present study was undertaken to address the various concerns that has limited the use of preoperative radiotherapy in rectal cancer in our institution. All patients diagnosed as having carcinoma rectum between August 2005 and July 2007 were included in the study. Group 1 patients consisted of those presenting with T2, T3 and T4 who received preoperative radiation of 25 Gy. Group 2 consisted of those with T4 tumours, who received Long course radiotherapy. Complication of radiation like dermatitis, enteritis and proctitis were noted. Before surgery CT scan and TRUS were repeated. In the postoperative period a record of abdominal, perineal wound complications and other complications were noted. The results were compared with a similar group of patients who did not receive preoperative radiotherapy. There were 21 patients (12males) with a mean age of 48.4 years (Range 18-70) in the radiotherapy group. Sixteen patients received short course (25 Gy) and five patients received long course of preoperative radiotherapy. Fourteen patients underwent definitive surgery in the form of abdominoperineal resection (APR) or anterior resection (AR). In the non-RT group there were 17 patients (8 males) with a mean age of 50.2 year. Fourteen patients underwent definitive surgery like APR (11) and AR (3). In the RT group CT scan and TRUS failed show any significant downsizing or down staging of tumour. In the RT group, incidence of acute skin toxicity was 23.8 % (5/21), all were seen in those who received long course of radiotherapy (Group 2). Grade 2 or 3 lower G I symptoms occurred in 3 (18.6 %) patients of Group 1 and 1(20 %) patient of group 2. There was higher incidence of perineal wound complication in the RT group (19.0 % vs 5.9 %). Preoperative long course of radiotherapy may be associated with high rates of dermatitis and perineal wound infection. Short course may be associated with lower G I toxicity.

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“…Their accuracy was comparable to ours. But in a metaanalysis by Kwok et al [10], the accuracy of TRUS in detecting rectal wall penetration was 87 %. Their stagespecific accuracy was.…”

Section: Discussionmentioning

confidence: 97%

“…TRUS fared poorly in detecting metastatic nodes in our study. Kwok [10] reported accuracy for nodal detection to be 66 % for CT, 72 % for TRUS and 74 % for MRI. The accuracy of CT scan in evaluating T-stage was 84.6 % in our study.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Radiotherapy in Carcinoma Rectum

Ramakrishnaiah

Thomas

Elangovan

et al. 2012

Indian J Surg Oncol

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“…In one study the sensitivity and specificity of CT for detecting mesorectal fat invasion was 53% (40). In a recently published meta-analysis of 78 studies, CT was 73% accurate for T staging (43). CT was accurate in identifying adjacent organ invasion (T4 tumors), but lacked spatial resolution to accurately evaluate less-advanced tumors (44).…”

Section: Discussionmentioning

confidence: 99%

Local staging of rectal cancer using combined pelvic phased‐array and endorectal coil MRI

Tatlı

Mortelé

Breen

et al. 2006

Magnetic Resonance Imaging

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Purpose:To assess the accuracy of MRI, using a pelvic phased-array coil and an endorectal coil, for preoperative local staging of rectal cancer. Materials and Methods:Fifty-one patients (26 males and 25 females) with adenocarcinoma of the rectum underwent preoperative MRI and surgical resection of their tumors. Surgical pathology staging was compared to MRI staging (using the TNM classification) obtained both retrospectively by a reader blinded to surgical findings and prospectively (radiological reports). In addition, patients were stratified according to surgical treatment groups (stage I ϭ T1-2/N0, stage II ϭ T3/N0, stage III ϭ Tx/N1-2).Results: At pathology, 36 of 51 (68%) tumors were classified as T0-T2, and 15 (32%) were classified as T3. Overall, the sensitivity and specificity of MRI readings for T3 staging were 93% and 86%, respectively (positive predictive value (PPV) ϭ 74%, negative predictive value (NPV) ϭ 97%, accuracy ϭ 88%). MRI correctly predicted lymph node metastases in 11 of 13 patients with a sensitivity of 85% and specificity of 69% (PPV ϭ 58%, NPV ϭ 90%, accuracy ϭ 74%). MRI correctly predicted surgical treatment groups in 33 of 39 (85%) patients. Interobserver agreement between the retrospective and prospective readings was excellent ( ϭ 0.85) for prediction of T3 tumor and good ( ϭ 0.80) for prediction of nodal involvement. Conclusion:Combined endorectal and pelvic phased-array coil MRI can be used reliably to select which patients should receive preoperative chemoradiotherapy. It is highly predictive in terms of excluding T3 tumors, but still has limitations in predicting lymph node metastasis.

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“…Accuracy of EUS is reduced following radiotherapy, due to the presence of inflammation and fibrosis 25 . EUS accuracy in N staging is similar to CT and MRI as benign inflammatory lymphadenopathy may accompany rectal cancer 26 .…”

Section: Rectal Cancermentioning

confidence: 99%