Role of Diffusion-Weighted Imaging in the Evaluation of Post-Treatment Tumor Response in Rectal Carcinoma

Qureshi, Pir Abdul Ahad; Aleem, Javaria; Mushtaq, Nadia; Noor, Muhammad Asif; Niazi, Imran Khalid; Altaf, Muhammad Omer

doi:10.7759/cureus.17471

Cited by 1 publication

(2 citation statements)

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“…2,3 Post neoadjuvant radiotherapy, the decision of whether the patients should be treated with standard TME, extended total mesorectal excision (eTME) or pelvic exenteration is based on the accuracy of restaging MRI, augmented with specific sequences such as diffusion-weighted imaging, to estimate the extent of MRF involvement relative to treatment-related fibrosis. [4][5][6] The multimodality management of primary LARC requiring either total or quadrant-based exenterative surgery was defined according to the beyond TME (bTME) consensus statement on evaluation and principles of management. 6 The bTME procedure includes posterior pelvic exenteration, total pelvic exenteration, extralevator abdominoperineal resection for inferior compartment involvement and sacral resection for posterior compartment involvement.…”

Section: Introductionmentioning

confidence: 99%

“…Patients with LARC and MRF involvement need surgical procedures that extend beyond the conventional total mesorectal excision (TME) plane; in fact, adjacent organ resections are required in >70% of the patients to achieve an R0 resection 2, 3 . Post neoadjuvant radiotherapy, the decision of whether the patients should be treated with standard TME, extended total mesorectal excision (eTME) or pelvic exenteration is based on the accuracy of restaging MRI, augmented with specific sequences such as diffusion‐weighted imaging, to estimate the extent of MRF involvement relative to treatment‐related fibrosis 4–6 …”

Section: Introductionmentioning

confidence: 99%

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Outcomes of extended total mesorectal excision in patients with locally advanced rectal cancer

et al. 2023

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Aim Extended total mesorectal excision (eTME) is a complex procedure involving en bloc resection of the structures surrounding the various quadrants of the rectum. This study, presenting the largest series so far of patients undergoing eTME, aimed to assess the surgical and survival outcomes of patients following treatment with eTME and to compare these outcomes with historical data on pelvic exenteration. Method The study is a retrospective review of all patients with locally advanced rectal cancer requiring an eTME (2014–2020). The database includes the demographic profile, operative details, histopathological features and follow‐up. Results One hundred and sixty three patients who underwent eTME were analysed. The overall Clavien–Dindo complication rate of > IIIa was 21.1%. The anterior quadrant was the most common anatomical site resected (68.5%). The R1 resection rate was 10.4%. After a median follow‐up of 28 months, there were 51 recurrences in the study and twenty two deaths were recorded. The local recurrence rate was 7.3% among the study population. The disease‐free survival (DFS) and overall survival were 66.7% and 80.4%, respectively, at 3 years. The majority of the recurrences were distant metastasis (84.3%). In univariate analysis, the quadrant involved did not affect survival. In multivariate analysis, signet ring histology, metastatic presentation, inadequate tumour response and R1 resection affected DFS. Conclusion The recurrence pattern, R1 resection rate and survival outcomes of patients in the present study were comparable with those for patients undergoing an exenteration. Therefore, eTME is probably a safe alternative to pelvic exenterations when R0 resection is achievable and when the procedure is performed in high‐volume specialist tertiary care centres.

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