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Ji J, Ali M, Wang W, Ren J, Wang L, Tang D, Wang D. Tumor size impact on TNM staging which define post-operative complications in rectal cancer. J Robot Surg 2024; 18:161. [PMID: 38578471 DOI: 10.1007/s11701-024-01920-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
The purpose of this study was to see how accurate tumor size was at predicting T and N stages in rectal malignancies. Tumor sizes of 40 mm and greater than 40 mm were used to assess post-operative challenges in related to T1-T2 and T3-T4 stages, as well as between node N0 and node N1 and N2 patients. A total of 131 patients were treated for colorectal cancer, with 54 patients < 40 mm and 77 patients > 40 mm receiving Da Vinci colorectal surgery. Conferring to the Clavien-Dindo classification grade III, there's an increase in the percentage of tumors > 40 mm, which also impacts the percentage of intestinal obstruction, anastomotic leakage, GERD, and sepsis with a P < 0.05. A tumor size of more than 40 mm is strongly associated with advanced pT stages. Tumor size may serve in addition to clinical staging and improve the management of rectal cancer.
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Affiliation(s)
- Jin Ji
- Department of Gastrointestinal Surgery, Clinical Medical College Yangzhou University, Northern Jiangsu People's Hospital Affiliated Yangzhou University, Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu, China
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Muhammad Ali
- Department of Gastrointestinal Surgery, Clinical Medical College Yangzhou University, Northern Jiangsu People's Hospital Affiliated Yangzhou University, Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu, China
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Wei Wang
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Jun Ren
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Liuhua Wang
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Dong Tang
- Medical College of Yangzhou University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Daorong Wang
- Department of Gastrointestinal Surgery, Clinical Medical College Yangzhou University, Northern Jiangsu People's Hospital Affiliated Yangzhou University, Yangzhou University, No.98 Nantong West Road, Yangzhou, Jiangsu, China.
- Medical College of Yangzhou University, Yangzhou, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China.
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China.
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Ghoneem E, Shabana ASA, El Sherbini M, Zuhdy M, Eldamshety O, Gouda M, El Shamy A, Saleh GA, Saleh AAG. Endoluminal ultrasound versus magnetic resonance imaging in assessment of rectal cancer after neoadjuvant therapy. BMC Gastroenterol 2022; 22:542. [PMID: 36575373 PMCID: PMC9793528 DOI: 10.1186/s12876-022-02628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Accurate rectal tumor staging guides the choice of treatment options. EUS and MRI are the main modalities for staging. AIM OF THE WORK To compare the performance of EUS and MRI for loco-regional staging of anorectal cancer after neo-adjuvant therapy. METHODS Seventy-three (37 male, 36 female) patients with rectal cancer after neo-adjuvant chemoradiotherapy were enrolled. Histopathological staging after surgery were used as reference for comparing the yield of loco-regional staging for EUS and MRI. EUS and MRI were done 1 month after completion of neo-adjuvant therapy. RESULTS Regarding post-surgical T staging, eight patients had early tumor (T2 = 16 and T1 = 9) and thirty six were locally advanced (T3 = 36), while N staging, forty patients with negative nodes and 33 were positive (N1 = 22 and N2 = 11). Comparing EUS to MRI, it showed a higher sensitivity (95.7% vs. 78.7%), specificity (84.6% vs. 68.0%) and accuracy (91.8% vs. 75.3%) for staging early and locally advanced tumor. Also, it had a higher sensitivity (78.8% vs. 69.7%), specificity (75.0% vs. 65.0%) and accuracy (76.7% vs. 67.1%) for detection of lymph nodes. CONCLUSION EUS appears to be more accurate than MRI in loco-regional staging of rectal carcinoma after neo-adjuvant therapy.
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Affiliation(s)
- Elsayed Ghoneem
- grid.10251.370000000103426662Department of Internal Medicine, Hepatology and Gastroenterology Unit, Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt ,Egyptian Liver Research Institute and Hospital, Sherbin, Mansoura, Egypt
| | - Ahmed Shekeib Abdein Shabana
- grid.10251.370000000103426662Department of Internal Medicine, Hepatology and Gastroenterology Unit, Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed El Sherbini
- grid.10251.370000000103426662Department of Internal Medicine, Hepatology and Gastroenterology Unit, Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammad Zuhdy
- grid.10251.370000000103426662Department of Surgical Oncology, Oncology Center Mansoura University (OCMU), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Osama Eldamshety
- grid.10251.370000000103426662Department of Surgical Oncology, Oncology Center Mansoura University (OCMU), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Gouda
- grid.420091.e0000 0001 0165 571XTheodor Bilharz Research Institute, Cairo, Egypt
| | - Ahmed El Shamy
- grid.10251.370000000103426662Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Gehad Ahmad Saleh
- grid.10251.370000000103426662Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Abdel Ghafar Saleh
- grid.10251.370000000103426662Department of Internal Medicine, Hepatology and Gastroenterology Unit, Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Zhang H, Wang C, Liu Y, Hu H, Wang G. A Preoperative Scoring System to Predict the Risk of Inadequate Lymph Node Count in Rectal Cancer. Front Oncol 2022; 12:938996. [PMID: 35875129 PMCID: PMC9304549 DOI: 10.3389/fonc.2022.938996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The aim of this study was to develop and validate a preoperative scoring system to stratify rectal cancer (RC) patients with different risks of inadequate lymph node examination. Methods A total of 1,375 stage I–III RC patients between 2011 and 2020 from the Second Affiliated Hospital of Harbin Medical University were included in the retrospective study and randomly divided into a development set (n = 688) and a validation set (n = 687). The logistic regression model was used to determine independent factors contributing to lymph node count (LNC) < 12. A preoperative scoring system was constructed based on beta (β) coefficients. The area under the receiver operating curve (AUC) was used to test model discrimination. Results Preoperative significant indicators related to LNC < 12 included age, tumor size, tumor location, and CEA. The AUCs of the scoring system for development and validation sets were 0.694 (95% CI = 0.648–0.741) and 0.666 (95% CI = 0.615–0.716), respectively. Patients who scored 0–2, 3–4, and 5–6 were classified into the low-risk group, medium-risk group, and high-risk group, respectively. Conclusions The preoperative scoring system could identify RC patients with high risk of inadequate lymphadenectomy accurately and further provide a reference to perform preoperative lymph node staining in targeted patients to reduce the difficulty of meeting the 12-node standard, with the purpose of accurate tumor stage and favorable prognosis.
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Neoadjuvant chemotherapy in locally advanced colon cancer: a systematic review. Tech Coloproctol 2020; 24:1001-1015. [PMID: 32666362 DOI: 10.1007/s10151-020-02289-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 07/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Preoperative or neoadjuvant chemotherapy (NAC) has emerged as a novel alternative to treat locally advanced colon cancer (LACC), as in other gastrointestinal malignancies. However, evidence of its efficacy and safety has not yet been gathered in the literature. The aim of the present study was to perform an extensive review of the scientific evidence for NAC in patients with LACC. METHODS PubMed, EMBASE, MEDLINE and Cochrane Library were searched for a systematic review of the literature from 2010 to 2019. Six eligible studies were included, with a total of 27,937 patients, 1232 of them (4.4%) treated with NAC. There were only one randomized controlled trial, three phase II non-randomized single arm studies and two retrospective studies. RESULTS The baseline computed tomography scan showed that most of patients had a T3 tumor. The completion rate of the planned neoadjuvant treatment ranged from 52.5 to 93.8%. Between 97.2 and 100% of patients had the scheduled surgery. The median tumor volume reduction after NAC ranged from 62.5 to 63.7%. The anastomotic leak rate in the NAC group ranged from 0 to 7%, with no cases of postoperative mortality. There was major pathological tumor regression in 4-34.7% of cases. Between 84 and 100% of NAC patients had R0-surgery. Survival after NAC seems to be encouraging although significant improvement has only been proven in T4b tumours. CONCLUSIONS According to our systematic review, the NAC may be a safe and effective emerging therapeutic alternative for treating LACC. This approach, which is still being tested, increases the reliance on accurate radiological staging.
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Abstract
BACKGROUND Adequate oncologic staging of rectal neoplasia is important for treatment and prognostic evaluation of the disease. Diagnostic methods such as endorectal ultrasound can assess rectal wall invasion and lymph node involvement. OBJECTIVE The purpose of this study was to correlate findings of 3-dimensional endorectal ultrasound and pathologic diagnosis of extraperitoneal rectal tumors with regard to depth of rectal wall invasion, lymph node involvement, percentage of rectal circumference involvement, and tumor extension. DESIGN Consecutive patients with extraperitoneal rectal tumors were prospectively assessed by 3-dimensional endorectal ultrasound blind to other staging methods and pathologic diagnosis. PATIENTS Patients who underwent endorectal ultrasound followed by surgery were included in the study. SETTINGS The study was conducted at a single academic institution. MAIN OUTCOME MEASURES Sensitivity, specificity, positive and negative predictive values, area under curve, and κ coefficient between 3-dimensional endorectal ultrasound and pathologic diagnosis were determined. Intraclass correlation coefficient was calculated for tumor extension and percentage of rectal wall involvement. RESULTS Forty-four patients (27 women; mean age = 63.5 years) were evaluated between September 2010 and June 2014. Most lesions were malignant (72.7%). For depth of submucosal invasion, 3-dimensional endorectal ultrasound showed sensitivity of 77.3%, specificity of 86.4%, positive predictive value of 85.0%, a negative predictive value of 79.2%, and an area under curve of 0.82. The weighted κ coefficient for depth of rectal wall invasion staging was 0.67, and there was no agreement between 3-dimensional endorectal ultrasound and pathologic diagnosis for lymph node involvement (κ = -0.164). Intraclass correlation coefficient for lesion extension and percentage of rectal circumference involvement were 0.45 and 0.66. A better correlation between 3-dimensional endorectal ultrasound and pathologic diagnosis was observed in tumors <5 cm and with <50% of rectal wall involvement. LIMITATIONS The relatively small sample size of patients with early rectal lesions referred directly for surgery could represent a potential selection bias. CONCLUSIONS Three-dimensional endorectal ultrasound was effective for determining rectal wall invasion and lesion extension in tumors <5 cm and with <50% of rectal wall invasion but was limited for detecting lymph node involvement in early rectal lesions.
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Rectal Tumour Staging with Endorectal Ultrasound: Is There Any Difference between Western and Eastern European Countries? Gastroenterol Res Pract 2015; 2016:8631381. [PMID: 26858754 PMCID: PMC4706948 DOI: 10.1155/2016/8631381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/27/2015] [Accepted: 07/05/2015] [Indexed: 12/17/2022] Open
Abstract
Background. Rectal tumour management depends highly on locoregional extension. Rectal endoscopic ultrasound (ERUS) is a good alternative to computed tomography and magnetic resonance imaging. However, in Hungary only a small amount of rectal tumours is examined with ERUS. Methods. Our retrospective study (2006–2012) evaluates the diagnostic accuracy of ERUS and compares the results, the first data from Central Europe, with those from Western Europe. The effect of neoadjuvant therapy, rectal probe type, and investigator's experience were also assessed. Results. 311 of the 647 ERUS assessed locoregional extension. Histological comparison was available in 177 cases: 67 patients underwent surgery alone; 110 received neoadjuvant chemoradiotherapy (CRT); ERUS preceded CRT in 77 and followed it in 33 patients. T-staging was accurate in 72% of primarily operated patients. N-staging was less accurate (62%). CRT impaired staging accuracy (64% and 59% for T- and N-staging). Rigid probes were more accurate (79%). At least 30 examinations are needed to master the technique. Conclusions. The sensitivity of ERUS complies with the literature. ERUS is easy to learn and more accurate in early stages but unnecessary for restaging after CRT. Staging accuracy is similar in Western and Central Europe, although the number of examinations should be increased.
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Yang Y, Peng W, Tang T, Xia L, Wang XD, Duan BF, Shu Y. MicroRNAs as promising biomarkers for tumor-staging: evaluation of MiR21 MiR155 MiR29a and MiR92a in predicting tumor stage of rectal cancer. Asian Pac J Cancer Prev 2015; 15:5175-80. [PMID: 25040971 DOI: 10.7314/apjcp.2014.15.13.5175] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE In this study, tumor-stage predictive abilities of miR21, miR155, miR29a and miR92a were evaluated in rectal cancer (RC). METHODS Expression of miR21, miR155, miR29a and miR92a was detected and quantitated in tumor tissue and in adjacent normal tissue from 40 patients by TaqMan MicroRNA assay. RESULTS Significant overexpression of miR21, miR155, miR29a and miR92a was observed in RC tissues. While high expression of miR21, miR155 and miR29a in N1-2 and C-D stages presented a potential correlation with N and Duke stages, partial correlation analysis suggested that only miR155 rather than miR21 and miR29a played a greater influencing role. Receiver operating characteristics (ROC) curve analysis showed that miR155 could discriminate N0 from N1-2 with 85.0% sensitivity and 85.0% specificity, N2 from N0-1 with 90.0% sensitivity and 96.7% specificity, and C-D stage from A-B stage with 81.0% sensitivity and 84.2% specificity. CONCLUSIONS Increase in expression of miR155 might represent a novel predictor for RC N and Dukes staging.
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Affiliation(s)
- Yun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China E-mail :
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Yang Y, Tang T, Peng W, Xia L, Wang X, Duan B, Shu Y. The comparison of miR-155 with computed tomography and computed tomography plus serum amyloid A protein in staging rectal cancer. J Surg Res 2014; 193:764-71. [PMID: 25261908 DOI: 10.1016/j.jss.2014.08.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/17/2014] [Accepted: 08/22/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recently identified class of microRNAs (miRNAs) provided a new insight in cancer research. As a member of miRNAs family, miR-155 expression demonstrated the correlation with tumor stage. Thus, its expression level can be potentially used for staging rectal tumors. The aim of this study was to systematically evaluate the potential abilities of miR-155 in preoperatively N staging. MATERIALS AND METHODS Expression of miR-155 was detected and quantitated in rectal cancer tissues and in adjacent nonmalignant tissues from 40 patients by TaqMan MicroRNA assays. Preoperative enhanced computed tomography (CT) scan, serum amyloid A protein (SAA), carcinoembryonic antigen (CEA), and postoperative pathologic biopsy were performed. RESULTS A significant overexpression of miR-155 was observed in rectal carcinoma tissues (0.137 ± 0.095 versus 0.093 ± 0.091, P = 0.043). High expression of miR-155 in N1-2 (0.09 ± 0.038 versus 0.183 ± 0.111, P = 0.001) and III and IV stages (0.091 ± 0.039 versus 0.178 ± 0.111, P = 0.002) presented its potential correlation with N and tumor-node-metastasis combined stages. Receiver operating characteristics curve analysis showed that miR-155 could discriminate N0 from N1-2 with 85.0% sensitivity and 85.0% specificity at the cutoff value of 0.125. miR-155 and CT had nearly equal performances in sensitivity (0.850 versus 0.700, P = 0.450) and specificity (0.850 versus 0.550, P = 0.077) in predicting N1-2 stage. Compared with CT + SAA, miR-155 had similar sensitivity (0.850 versus 0.950, P = 0.617) but higher specificity (0.750 versus 0.200, P = 0.015) for lymph node assessment. CONCLUSIONS Increase in the expression of miR-155 might represent a potential valuable marker for rectal carcinoma N and combined tumor-node-metastasis staging.
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Affiliation(s)
- Yun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Tian Tang
- Department of Hepatic Surgery and Hepatic Transplantation Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Wei Peng
- Department of Gynecology and Obstetrics, West China Women's and Children's Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Lin Xia
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaodong Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Baofeng Duan
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ye Shu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Fernández-Martínez D, Rodríguez-Infante A, Castelo-Álvarez E, Fernández-Vega I, Suárez-Hevia M, Truán-Alonso N, Baldonedo-Cernuda RF, Alvarez-Pérez JA, Sánchez-Farpón H. Combined radical prostatectomy and abdominoperineal resection for locally invasive rectal cancer. Int J Surg Case Rep 2014; 5:584-8. [PMID: 25105771 PMCID: PMC4201019 DOI: 10.1016/j.ijscr.2014.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/29/2014] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION An infiltration of urological organs is found in 5–10% of patients with colorectal carcinoma. Total pelvic exenteration is the standard procedure for locally advanced rectal cancer. In selected patients with rectal cancer involving the prostate or seminal vesicles, the bladder can be preserved and en bloc radical prostatectomy with abdominoperineal rectal resection can be performed. We report two patients who treated with this combined approach. PRESENTATION OF CASE Two patients with symptoms of rectal bleeding and pelvic pain were investigated. Colonoscopy demonstrated a tumor in the lower rectum. Biopsies revealed adenocarcinoma. Both pelvic MRI and endorectal ultrasound showed tumors that invaded the prostate and the seminal vesicles directly but without invasion of the bladder. After neoadjuvant chemoradiation, combined radical prostatectomy and abdominoperineal amputation was performed. None has developed local recurrence, but one of them was operated on for a single lung metastasis. After a follow-up of 28 and 20 months, respectively, the patients are alive without evidence of local recurrence or distant disease. DISCUSSION This procedure obviates the need for urinary diversion without compromising the local tumor control. Intraoperative and postoperative diagnostic difficulties, and clinical aspects in relation to postoperative anastomotic leak and survival of patients are discussed. CONCLUSION En bloc radical prostatectomy and proctosigmoidectomy is feasible in selected patients with rectal cancer and invasion limited to the prostate or seminal vesicles because it provides good local tumor control and significantly improves the patient's quality of life in comparison to total pelvic exenteration.
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Affiliation(s)
- Daniel Fernández-Martínez
- Unit of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Antonio Rodríguez-Infante
- Unit of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Elsa Castelo-Álvarez
- Unit of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Iván Fernández-Vega
- Department of Pathology, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Miguel Suárez-Hevia
- Department of Urology, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Nuria Truán-Alonso
- Unit of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Ricardo F Baldonedo-Cernuda
- Unit of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - José A Alvarez-Pérez
- Unit of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Herminio Sánchez-Farpón
- Unit of Coloproctology, Department of General and Digestive Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain.
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Arredondo J, González I, Baixauli J, Martínez P, Rodríguez J, Pastor C, Ribelles MJ, Sola JJ, Hernández-Lizoain JL. Tumor response assessment in locally advanced colon cancer after neoadjuvant chemotherapy. J Gastrointest Oncol 2014; 5:104-11. [PMID: 24772338 DOI: 10.3978/j.issn.2078-6891.2014.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/12/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Preoperative chemotherapy followed by radical surgery is a novel therapeutic approach for locally advanced colon cancer (LACC). Neoadjuvant strategies require highly accurate diagnostic tests for a proper selection of candidate patients, allowing a low risk of overtreatment. This paper assesses the radiological, metabolic and pathological findings induced by preoperative oxaliplatin and fluoropyrimidines-based chemotherapy in LACC. METHODS Forty-four consecutive patients with a confirmed diagnosis of LACC who received neoadjuvant chemotherapy and colon surgery were included. All patients were staged at baseline and before surgery. Clinical diagnosis consisted of physical examination, endoscopy with biopsy and computed tomography (CT) scan. In selected cases, a positron emission tomography/CT (PET/CT) scan was also performed. Accuracy and correlations between CT scan findings and pathologic report was assayed for T stage, N stage and TN stage. This study is retrospective in design. RESULTS After chemotherapy, a statistical significant tumor volume reduction of 62.5% was achieved by CT-scan (P<0.001; Wilcoxon test) and a 38.9% decrease of standard uptake value (SUVmax) was observed on PET/CT (P=0.004). No progressive disease was reported during neoadjuvant treatment. Accuracy for T and N classification was 62% and 87%, respectively. Accuracy for TN stage was 77%, with 13.6% and 9.1% of the patients being under or overstaged, respectively. Pathologic stage II and III disease was observed in 29/44 (65.9%) and 15/44 (34.1%) of the patients, respectively. Pathologic complete response was achieved in three patients. CONCLUSIONS Oxaliplatin/fluorpyrimidine neoadjuvant chemotherapy induces major tumour shrinkage at both the pathological and radiological levels. The CT scan shows a high accuracy and a low overstaged rate in LACC patients treated by means of a neoadjuvant approach.
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Affiliation(s)
- Jorge Arredondo
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ignacio González
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jorge Baixauli
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Patricia Martínez
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Javier Rodríguez
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Carlos Pastor
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - María Jesús Ribelles
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jesús Javier Sola
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - José Luís Hernández-Lizoain
- 1 Department of General Surgery, 2 Department of Radiology, 3 Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain ; 4 Department of General Surgery, Fundación Jiménez Díaz, Madrid, Spain ; 5 Department of Nuclear Medicine, 6 Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
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Bor R, Fábián A, Farkas K, Bálint A, Tiszlavicz L, Wittmann T, Nagy F, Molnár T, Szepes Z. [The role of endoscopic ultrasonography in the diagnosis of rectal cancers]. Orv Hetil 2013; 154:1337-44. [PMID: 23955969 DOI: 10.1556/oh.2013.29686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The exact extent of rectal cancer and regional lymph node involvement are essential for providing the optimal treatment. AIM The aim of the authors was to evaluate the diagnostic accuracy of endoscopic ultrasonography in routine clinical staging of rectal cancer. METHOD Outcomes of endoscopic ultrasonography performed between 2006 and 2012 for rectal cancer staging were retrospectively analyzed. The correlation between the endoscopic and pathological stages was evaluated. RESULTS In patients without neoadjuvant chemotherapy the sensitivity (75% and 73%) and specificity (74% and 80%) of endoscopic ultrasonography for differentiating T1 and T2 stages (respectively) were high, however, it was significantly decreased in differentiation of T3 stage (58%). A weak association was found in different N stages (45-62%). The diagnostic accuracy of endoscopic ultrasound was reduced significantly after the oncological treatment due to the overevaluation (27%) of the findings. After a relatively short learning curve (30 examinations) high correlation was detected between pT and uT stages. CONCLUSIONS Endoscopic ultrasonography provides great help in staging early rectal cancers. Due to the lower sensitivity in patients receiving neoadjuvant therapy, it is not a useful tool after down-staging.
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Affiliation(s)
- Renáta Bor
- Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Korányi fasor 8-10. 6720
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12
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Keller DS, Paspulati R, Kjellmo A, Rokseth KM, Bankwitz B, Wibe A, Delaney CP. MRI-defined height of rectal tumours. Br J Surg 2013; 101:127-32. [DOI: 10.1002/bjs.9355] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 12/28/2022]
Abstract
Abstract
Background
There is no standard for reporting rectal cancer distances from the distal resection margin in the literature. The objective was to demonstrate the importance of rectal cancer measurement from a standardized point.
Methods
Review of databases at two international institutions identified 50 patients with rectal adenocarcinoma within 15 cm of the anal verge (AV), who had preoperative magnetic resonance imaging (MRI) and underwent surgery with curative intent. Expert radiologists reviewed the magnetic resonance images for anatomical distances from the anorectal ring (ARR) to the AV, from the ARR to the dentate line (DL), and from the DL to the AV. Anatomical measurements were compared with preoperative measurements to assess reporting inconsistencies.
Results
Fifty patients with rectal adenocarcinoma were included in the study. The mean(s.d.) anatomical distance was 1·66(0·61) cm from the ARR to the DL, 3·78(0·61) cm from the ARR to the AV (maximum 5·5 cm) and 2·11(0·10) cm from the DL to the AV. The mean radiological distance from the distal tumour was 2·90(1·60) (median 3·2, range 0–7·5) cm to the ARR, 4·36(3·20) (median 4·2, range −0·5 to 12·8) cm to the DL and 6·13(3·39) (median 6·0, range 0–14·1) cm to the AV. There was a significant difference in the distal tumour margin between measurements made by the expert radiologists and reported preoperative measurements (P < 0·001). Significant differences were also found between the expert radiologists' MRI and rigid proctoscopic measurements (P = 0·025).
Conclusion
There was up to 5·5 cm variation, depending on which landmark was chosen for reporting the distal margin of rectal cancer. This has potential implications for surgical planning, interpreting radiological images and comparative studies.
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Affiliation(s)
- D S Keller
- Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - R Paspulati
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - A Kjellmo
- Department of Radiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - K M Rokseth
- Department of Radiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - B Bankwitz
- Department of Statistics, Case Western Reserve University, Cleveland, Ohio, USA
| | - A Wibe
- Department of Surgery, Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - C P Delaney
- Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Swartling T, Kälebo P, Derwinger K, Gustavsson B, Kurlberg G. Stage and size using magnetic resonance imaging and endosonography in neoadjuvantly-treated rectal cancer. World J Gastroenterol 2013; 19:3263-3271. [PMID: 23745028 PMCID: PMC3671078 DOI: 10.3748/wjg.v19.i21.3263] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/14/2013] [Accepted: 04/29/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the stage and size of rectal tumours using 1.5 Tesla (1.5T) magnetic resonance imaging (MRI) and three-dimensional (3D) endosonography (ERUS).
METHODS: In this study, patients were recruited in a phase I/II trial of neoadjuvant chemotherapy for biopsy-proven rectal cancer planned for surgical resection with or without preoperative radiotherapy. The feasibility and accuracy of 1.5T MRI and 3D ERUS were compared with the histopathology of the fixed surgical specimen (pathology) to determine the stage and size of the rectal cancer before and after neoadjuvant chemotherapy. A Philips Intera 1.5T with a cardiac 5-channel synergy surface coil was used for the MRI, and a B-K Medical Falcon 2101 EXL 3D-Probe was used at 13 MHz for the ERUS. Our hypothesis was that the staging accuracy would be the same when using MRI, ERUS and a combination of MRI and ERUS. For the combination, MRI was chosen for the assessment of the lymph nodes, and ERUS was chosen for the assessment of perirectal tissue penetration. The stage was dichotomised into stage I and stage II or greater. The size was measured as the supero-inferior length and the maximal transaxial area of the tumour.
RESULTS: The staging feasibility was 37 of 37 for the MRI and 29 of 36 for the ERUS, with stenosis as a limiting factor. Complete sets of investigations were available in 18 patients for size and 23 patients for stage. The stage accuracy by MRI, ERUS and the combination of MRI and ERUS was 0.65, 0.70 and 0.74, respectively, before chemotherapy and 0.65, 0.78 and 0.83, respectively, after chemotherapy. The improvement of the post-chemotherapy staging using the combination of MRI and ERUS compared with the staging using MRI alone was significant (P = 0.046). The post-chemotherapy understaging frequency by MRI, ERUS and the combination of MRI and ERUS was 0.18, 0.14 and 0.045, respectively, and these differences were non-significant. The measurements of the supero-inferior length by ERUS compared with MRI were within 1.96 standard deviations of the difference between the methods (18 mm) for tumours smaller than 50 mm. The agreement with pathology was within 1.96 standard deviations of the difference between imaging and pathology for all tumours with MRI (15 mm) and for tumours that did not exceed 50 mm with ERUS (22 mm). Tumours exceeding 50 mm in length could not be reliably measured by ERUS due to the limit in the length of each recording.
CONCLUSION: MRI is preferable to use when assessing the size of large or stenotic rectal tumours. However, staging accuracy is improved by combining MRI with ERUS.
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Du P, Duan WM, Jin HQ, Liu D. Role of endoscopic ultrasonography in the staging and treatment of colorectal carcinoma. Shijie Huaren Xiaohua Zazhi 2012; 20:2638-2641. [DOI: 10.11569/wcjd.v20.i27.2638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the use of endoscopic ultrasonography (EUS) in the staging and treatment of colorectal carcinoma.
METHODS: Fifty-six patients who were diagnosed with colorectal cancer by endoscopic biopsy in our department underwent EUS staging (TN). According to the results of EUS staging, the patients were treated with surgery. After postoperative pathologic staging, the patients with stage 2 and stage 3 disease were given adjuvant chemotherapy. Using postoperative pathology as a gold standard, the accuracy of EUS staging was calculated. The patients were followed for over two years and the rate of recurrence was calculated.
RESULTS: The accuracy rates of uT staging for colorectal cancer were 88.89% (T1), 83.33% (T2), 85.71% (T3), and 75.00% (T4), and the total accuracy rate of uT staging for colorectal cancer is 83.23%. The accuracy rates of uN staging were 81.25% (uN(+)) and 80% (uN(-)), and the total accuracy rate of uN staging is 80.63%. Six (10.71%) patients had recurrence.
CONCLUSION: EUS is useful for the staging and treatment of colorectal cancer.
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Wang Y, Zhou CW, Hao YZ, Li L, Liu SM, Feng XL, Zhou ZX, Leung VYF. Improvement in T-staging of rectal carcinoma: using a novel endorectal ultrasonography technique with sterile coupling gel filling the rectum. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:574-579. [PMID: 22305079 DOI: 10.1016/j.ultrasmedbio.2011.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 12/21/2011] [Accepted: 12/29/2011] [Indexed: 05/31/2023]
Abstract
Our purpose was to study the accuracy of using endorectal ultrasonography (ERUS) with sterile coupling gels filling the rectum in the preoperative T-staging of rectal carcinoma. A total of 189 patients with confirmed rectal carcinoma were recruited. All underwent ERUS and surgery within the week following sonography. EURS was performed by introducing sterile coupling gel into the rectum. Two radiologists looked at the images at the same time and agreed upon staging. Rectal carcinoma was staged from Tis to T4. The accuracy of T-staging by ERUS was 89.95%. The sensitivity, specificity, PPV and NPV for ERUS at different stages were calculated. For early stage (Tis and T1), these values were 93.62%, 97.89%, 93.62% and 97.89%, respectively. ERUS filling with sterile coupling gel in the rectum overcomes the pressure effect from a water bath and the restriction caused by tumor stenosis, thus, greatly improving the accuracy of T-staging. The examination is real-time, safe and inexpensive.
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Affiliation(s)
- Yong Wang
- Department of Diagnostic Imaging, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Hu B, Ren D, Su D, Lin H, Xian Z, Wan X, Zhang J, Fu X, Jiang L, Diao D, Fan X, Wang L, Wang J. Expression of the phosphorylated MEK5 protein is associated with TNM staging of colorectal cancer. BMC Cancer 2012; 12:127. [PMID: 22458985 PMCID: PMC3337320 DOI: 10.1186/1471-2407-12-127] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 03/30/2012] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Activation of MEK5 in many cancers is associated with carcinogenesis through aberrant cell proliferation. In this study, we determined the level of phosphorylated MEK5 (pMEK5) expression in human colorectal cancer (CRC) tissues and correlated it with clinicopathologic data. METHODS pMEK5 expression was examined by immunohistochemistry in a tissue microarray (TMA) containing 335 clinicopathologic characterized CRC cases and 80 cases of nontumor colorectal tissues. pMEK5 expression of 19 cases of primary CRC lesions and paired with normal mucosa was examined by Western blotting. The relationship between pMEK5 expression in CRC and clinicopathologic parameters, and the association of pMEK5 expression with CRC survival were analyzed respectively. RESULTS pMEK5 expression was significantly higher in CRC tissues (185 out of 335, 55.2%) than in normal tissues (6 out of 80, 7.5%; P < 0.001). Western blotting demonstrated that pMEK5 expression was upregulated in 12 of 19 CRC tissues (62.1%) compared to the corresponding adjacent nontumor colorectal tissues. Overexpression of pMEK5 in CRC tissues was significantly correlated to the depth of invasion (P = 0.001), lymph node metastasis (P < 0.001), distant metastasis (P < 0.001) and high preoperative CEA level (P < 0.001). Consistently, the pMEK5 level in CRC tissues was increased following stage progression of the disease (P < 0.001). Analysis of the survival curves showed a significantly worse 5-year disease-free (P = 0.002) and 5-year overall survival rate (P < 0.001) for patients whose tumors overexpressed pMEK5. However, in multivariate analysis, pMEK5 was not an independent prognostic factor for CRC (DFS: P = 0.139; OS: P = 0.071). CONCLUSIONS pMEK5 expression is correlated with the staging of CRC and its expression might be helpful to the TNM staging system of CRC.
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Affiliation(s)
- Bang Hu
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China
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Fernández-Esparrach G, Ayuso-Colella JR, Sendino O, Pagés M, Cuatrecasas M, Pellisé M, Maurel J, Ayuso-Colella C, González-Suárez B, Llach J, Castells A, Ginès A. EUS and magnetic resonance imaging in the staging of rectal cancer: a prospective and comparative study. Gastrointest Endosc 2011; 74:347-54. [PMID: 21802588 DOI: 10.1016/j.gie.2011.03.1257] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 03/30/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Accurate locoregional staging is crucial in rectal cancer for deciding patient management because the administration of neoadjuvant therapy depends on it. EUS and magnetic resonance imaging (MRI) are used indistinctly in the pretherapeutic workup of rectal cancer. OBJECTIVE To prospectively compare the performance of EUS and MRI in the locoregional staging of rectal cancer in a large series of patients. DESIGN Prospective and comparative study. SETTING Tertiary center. PATIENTS Patients with histologically proven rectal cancer. INTERVENTIONS EUS and MRI were performed in all patients by a different operator unaware of the results of the other procedure. MAIN OUTCOME MEASUREMENTS Epidemiological, clinical, radiological, and echographic variables were evaluated. Pathological examination of the surgical specimen was used as the criterion standard. RESULTS Ninety patients (54 men and 36 women with a mean age of 68 ± 12 years; range 33-87 years) constitute the final sample of this study. Most of the tumors were stages T2-T3 (85%; 95% CI, 77%-92%). Twenty of them (22%; 95% CI, 14%-32%) were stenotic and 24 (27%; 95% CI, 18%-37%) had polypoid morphology. The accuracy of T staging was very similar for EUS and MRI for stage T2 (76%; 95% CI, 65%-84% and 77%; 95% CI, 67%-85%, respectively; P = not significant) and stage T3 (76%; 95% CI, 65%-84% and 83%, 95% CI, 73%-90%, respectively; P = not significant). MRI was not able to visualize any T1 tumor, whereas EUS understaged all T4 tumors. The univariate analysis showed that the polypoid morphology of the tumor inversely correlated with T staging on MRI. The accuracy of MRI for N staging was higher than that of EUS, although the difference did not reach statistical significance (79%; 95% CI, 65%-88% and 65%; 95% CI, 51%-78%, respectively). When performing the univariate analysis to assess the reasons for this difference, the presence of a stenotic tumor was the only parameter significantly related to a poorer performance of EUS in N staging. LIMITATIONS The small number of early and locally advanced lesions. CONCLUSIONS EUS and MRI have similar accuracy in the T and N staging in rectal cancer. The presence of stenosis and polypoid morphology is inversely associated with accuracy for either EUS or MRI.
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Affiliation(s)
- Glòria Fernández-Esparrach
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, IDIBAPS, CIBERehd, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Xu L, Zhou Y, Qiu D. Correlation between calcified liver metastases and histopathology of primary colorectal carcinoma in Chinese. ACTA ACUST UNITED AC 2010; 30:815-8. [PMID: 21181378 DOI: 10.1007/s11596-010-0664-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Indexed: 12/12/2022]
Abstract
The study examined the association between calcified liver metastases and the histopathology of the primary colorectal carcinoma in Chinese. The clinical, pathological and CT data were retrospectively analyzed in 210 patients (mean age: 54.2 years) with liver metastases from colorectal carcinoma. Plain CT scanning and contrast-enhanced scanning were performed in all the patients. For the contrast-enhanced examination, iohexol was injected by using a high pressure syringe at a flow rate of 2.5-3.0 mL/s. The arterial phase lasted approximately 25 s and the portal venous phase about 60 s. All patients had no history of chronic liver diseases and had never received interventional treatments. χ(2)-test was used to analyze the rate of calcification in the liver metastasis from colorectal cancer of different differentiation degrees. Among the 210 cases of liver metastases, 22 patients (10.5%) were found to have calcified liver metastases on CT scan. Two patients with calcified liver metastasis received lumpectomy and developed calcification in recurrent tumors. Another two patients had calcification in newly developed tumor masses. And the calcification in the newly developed masses was similar to that of their primary counterparts in terms of morphology and distribution. On the enhanced CT scan, the tumors exhibited no enhancement during hepatic arterial phase and showed slight rim enhancement during portal venous scan in the 22 cases. The calcification became obscure on contrast-enhanced scans. Histopathologically, the primary tumors were well-differentiated adenocarcinoma in 6 cases, moderately-differentiated adenocarcinoma in 10, poorly-differentiated adenocarcinoma in 4 and mucinous adenocarcinoma in 2 among the 22 cases. No statistical correlation was noted between the incidence of calcified liver metastasis and the pathological subtypes and differentiation degrees of the primary colorectal carcinoma. It was concluded that calcified liver metastases may result from colorectal adenocarcinomata of different differentiation degrees or mucinous adenocarcinomata in Chinese population. There is no correlation between calcification of liver metastases and the pathological subtype of the primary colorectal carcinoma in Chinese, which is different from the findings that calcified metastases were associated with colorectal mucinous adenocarcinoma in other ethnic groups.
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Affiliation(s)
- Liying Xu
- Department of Radiology, Zhongnan Hospital, Wuhan University, Wuhan 430071, China.
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Magnetic resonance imaging (MRI) in rectal cancer: a comprehensive review. Insights Imaging 2010; 1:245-267. [PMID: 22347920 PMCID: PMC3259411 DOI: 10.1007/s13244-010-0037-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 07/11/2010] [Accepted: 07/26/2010] [Indexed: 02/07/2023] Open
Abstract
Magnetic resonance imaging (MRI) has established itself as the primary method for local staging in patients with rectal cancer. This is due to several factors, most importantly because of the ability to assess the status of circumferential resection margin. There are several newer developments being introduced continuously, such as diffusion-weighted imaging and imaging with 3 T. Assessment of loco-regional lymph nodes has also been investigated extensively using different approaches, but more work needs to be done. Finally, evaluation of tumours during or after preoperative treatment is becoming an everyday reality. All these new aspects prompt a review of the most recent advances and opinions. In this review, a comprehensive overview of the current status of MRI in the loco-regional assessment and management of rectal cancer is presented. The findings on MRI and their accuracy are reviewed based on the most up-to-date evidence. Optimisation of MRI acquisition and relevant regional anatomy are also presented, based on published literature and our own experience.
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Zlobec I, Minoo P, Karamitopoulou E, Peros G, Patsouris ES, Lehmann F, Lugli A. Role of tumor size in the pre-operative management of rectal cancer patients. BMC Gastroenterol 2010; 10:61. [PMID: 20550703 PMCID: PMC2900221 DOI: 10.1186/1471-230x-10-61] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 06/15/2010] [Indexed: 12/11/2022] Open
Abstract
Background Clinical management of rectal cancer patients relies on pre-operative staging. Studies however continue to report moderate degrees of over/understaging as well as inter-observer variability. The aim of this study was to determine the sensitivity, specificity and accuracy of tumor size for predicting T and N stages in pre-operatively untreated rectal cancers. Methods We examined a test cohort of 418 well-documented patients with pre-operatively untreated rectal cancer admitted to the University Hospital of Basel between 1987 and 1996. Classification and regression tree (CART) and logistic regression analysis were carried out to determine the ability of tumor size to discriminate between early (pT1-2) and late (pT3-4) T stages and between node-negative (pN0) and node-positive (pN1-2) patients. Results were validated by an external patient cohort (n = 28). Results A tumor diameter threshold of 34 mm was identified from the test cohort resulting in a sensitivity and specificity for late T stage of 76.3%, and 67.4%, respectively and an odds ratio (OR) of 6.67 (95%CI:3.4-12.9). At a threshold value of 29 mm, sensitivity and specificity for node-positive disease were 94% and 15.5%, respectively with an OR of 3.02 (95%CI:1.5-6.1). Applying these threshold values to the validation cohort, sensitivity and specificity for T stage were 73.7% and 77.8% and for N stage 50% and 75%, respectively. Conclusions Tumor size at a threshold value of 34 mm is a reproducible predictive factor for late T stage in rectal cancers. Tumor size may help to complement clinical staging and further optimize the pre-operative management of patients with rectal cancer.
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Affiliation(s)
- Inti Zlobec
- Institute of Pathology, University Hospital of Basel, Basel, Switzerland.
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Koebrugge B, Bosscha K, Jager G, Ernst M. Accuracy of transrectal ultrasonography in staging rectal tumors that are clinically eligible for transanal endoscopic microsurgery. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:250-253. [PMID: 20186761 DOI: 10.1002/jcu.20680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Transanal endoscopic microsurgery (TEM) is performed in patients with premalignant or selected stage T1 rectal lesions. Transrectal ultrasonography (TRUS) is an important tool in the preoperative staging of rectal lesions to determine whether lesions are suitable for TEM or not. We analyze the accuracy of TRUS in distinguishing between rectal lesions requiring TEM or more radical excision. METHODS From 2006 to 2008 thirty-five patients were included. All patients underwent TRUS. Following TRUS and/or additional imaging, patients underwent surgery. Preoperative TRUS staging was correlated to postoperative pathology findings. RESULTS In 30 patients TRUS was diagnostic. Postoperative pathologic findings confirmed the preoperative TRUS findings in 29 patients; in 1 patient, a T3 staged tumor was an overstaged lesion biopsied as a tubulovillous adenoma. The accuracy level in the diagnostic TRUS group was 97% (29/30). In 5 patients TRUS was nondiagnostic; in 4 of these patients MRI was performed showing no tumor invasion in all 4 patients, confirmed by pathologic findings. Correct TRUS interpretation was possible in 86% (30/35). Overall accuracy of TRUS was 83% (29/35). CONCLUSION TRUS is accurate in distinguishing rectal lesions suitable for TEM from the lesions needing more radical surgery. If TRUS is nondiagnostic or the lesion is of high stage (>or=T2), MRI should be performed.
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Affiliation(s)
- Boukje Koebrugge
- Department of Surgery, Jeroen Bosch Hospital's, Hertogenbosch, The Netherlands
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Wang X, Lv D, Song H, Deng L, Gao Q, Wu J, Shi Y, Li L. Multimodal preoperative evaluation system in surgical decision making for rectal cancer: a randomized controlled trial. Int J Colorectal Dis 2010; 25:351-8. [PMID: 19921223 PMCID: PMC2814035 DOI: 10.1007/s00384-009-0839-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2009] [Indexed: 02/05/2023]
Abstract
PURPOSE Multimodal preoperative evaluation (MPE) is a novel strategy for surgical decision making, incorporating the transrectal ultrasound (TRUS), 64 multi-slice spiral computer tomography (MSCT), and serum amyloid A protein (SAA) for rectal cancer. This trial aims to determine the accuracy of MPE in preoperative staging and its role in surgical decision making for rectal cancer. METHODS Two hundred twenty-five participants with histologically proven rectal cancer with tumor height less than 10 cm were randomly assigned into three arms in the ratio 1:1:1. Arm A (MPE) was multimodal staged by the combination of MSCT, TRUS, and SAA. Arm B (MSCT+SAA) was staged by MSCT and SAA. Arm C (MSCT) was staged only by MSCT. The primary endpoints were the accuracy of preoperative staging and expected surgical procedures. This study is registered as an International Standard Randomised Controlled Trial, number ChiCTR-DT-00000409. RESULTS The analysis showed statistical difference in the accuracy of T staging between arm A and B (94.6% vs. 77.8%, P=0.003) and arm A and C (94.6% vs. 80.6%, P=0.010). Statistical difference was also observed between the accuracies of preoperative N staging between arm A and C (85.1% vs. 69.4%, P=0.023) and arm A and B (85.1% vs. 84.7%, P=0.029). Surgical decision making in arm A was more accurate than that in arm C (95.9% vs. 80.6%, P=0.001). Pathological T stage (P<0.001), N stage (P<0.001), tumor node metastasis stage (P<0.001), serum level of SAA (P=0.002), and tumor height (P=0.030) were significantly associated with final surgical procedures. CONCLUSION MPE is an effective strategy in preoperative staging and more accurate than other available strategies in surgical decision making for rectal cancer.
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Affiliation(s)
- Xiaodong Wang
- Anal-Colorectal Surgery, West China Hospital, Sichuan University, 37, Guo Xue Xiang, Chengdu, China 610041
| | - Donghao Lv
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Huan Song
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Lei Deng
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Qiang Gao
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Junhua Wu
- Radiology, West China Hospital, Chengdu, China
| | - Yingyu Shi
- Sonography, West China Hospital, Chengdu, China
| | - Li Li
- Anal-Colorectal Surgery, West China Hospital, Sichuan University, 37, Guo Xue Xiang, Chengdu, China 610041
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Abstract
It is essential in treating rectal cancer to have adequate preoperative imaging, as accurate staging can influence the management strategy, type of resection, and candidacy for neoadjuvant therapy. In the last twenty years, endorectal ultrasound (ERUS) has become the primary method for locoregional staging of rectal cancer. ERUS is the most accurate modality for assessing local depth of invasion of rectal carcinoma into the rectal wall layers (T stage). Lower accuracy for T2 tumors is commonly reported, which could lead to sonographic overstaging of T3 tumors following preoperative therapy. Unfortunately, ERUS is not as good for predicting nodal metastases as it is for tumor depth, which could be related to the unclear definition of nodal metastases. The use of multiple criteria might improve accuracy. Failure to evaluate nodal status could lead to inadequate surgical resection. ERUS can accurately distinguish early cancers from advanced ones, with a high detection rate of residual carcinoma in the rectal wall. ERUS is also useful for detection of local recurrence at the anastomosis site, which might require fine-needle aspiration of the tissue. Overstaging is more frequent than understaging, mostly due to inflammatory changes. Limitations of ERUS are operator and experience dependency, limited tolerance of patients, and limited range of depth of the transducer. The ERUS technique requires a learning curve for orientation and identification of images and planes. With sufficient time and effort, quality and accuracy of the ERUS procedure could be improved.
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Kim MJ. Preoperative Radiological Staging of Rectal Cancer. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2009. [DOI: 10.5124/jkma.2009.52.5.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Min Ju Kim
- Department of Radiology, Korea University College of Medicine, Korea.
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28
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Wang G, Wang X, Wang S, Song H, Sun H, Yuan W, Cao B, Bai J, Fu S. Colorectal cancer progression correlates with upregulation of S100A11 expression in tumor tissues. Int J Colorectal Dis 2008; 23:675-82. [PMID: 18340452 DOI: 10.1007/s00384-008-0464-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Early detection and treatment of human colorectal cancers remain a challenge. Identification of new potential markers may help in the diagnosis of colorectal cancer. MATERIALS AND METHODS By comparative two-dimensional gel electrophoresis using extracts from colorectal tumor and adjacent normal tissues, we identified a calcium-binding protein, S100A11, which was highly expressed in colorectal cancer compared with adjacent normal tissues. We expanded our study in 89 clinical colorectal tumor samples to validate this finding and correlates S100A11 expression in human colorectal cancer tissues with various stages of the tumor by Western blotting and immunohistochemical staining. RESULTS We identified a calcium-binding protein, S100A11, which was highly expressed in colorectal cancer compared with adjacent normal tissues. S100A protein was expressed predominantly in the cytoplasm of normal tissue; however, it was expressed in both the nuclei and cytoplasm of colorectal cancer. S100A11 level in colorectal cancer tissue was increased following stage progression of the disease. CONCLUSION These findings suggest S100A11 could be helpful in the pathological study of colorectal cancer, especially for the classification of different stages in colorectal cancer.
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Affiliation(s)
- Guiyu Wang
- Department of Abdominal Surgery, The Affiliated Tumor Hospital, Harbin Medical University, Harbin 150086, China
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29
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Bader FG, Bouchard R, Lubienski A, Keller R, Mirow L, Czymek R, Habermann JK, Bruch HP, Roblick UJ. [Progress in diagnostics of anorectal disorders. Part II: radiology]. Chirurg 2008; 79:410-7. [PMID: 18418564 DOI: 10.1007/s00104-008-1544-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Diagnostics and therapy of anorectal disorders remain a surgical question. In close cooperation between different departments (radiology and gastroenterology, urology and gynecology, dermatology and psychology), the role of radiologic imaging is of growing importance. Exact knowledge of functional anatomy and precise clinical examination constitute the basis of the according therapeutic strategies. In this context radiology has contributed decisively. Developments in imaging techniques, e.g. dynamic MRI, highly contributed to better understanding of complex functional pelvic floor disorders. The combination of nanotechnology and high-resolution imaging allows precise staging, especially in rectal cancer. Furthermore, advances in virtual colonoscopy could lead to widely acceptable and patient-friendly screening for colorectal malignancies.
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Affiliation(s)
- F G Bader
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburgerallee 160, 23538 Lübeck
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30
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Rovera F, Dionigi G, Boni L, Cutaia S, Diurni M, Dionigi R. The role of EUS and MRI in rectal cancer staging. Surg Oncol 2007; 16 Suppl 1:S51-2. [PMID: 18032030 DOI: 10.1016/j.suronc.2007.10.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Rectal cancer continues to be one of the most common tumors worldwide. Its prognosis mainly depends on early diagnosis and precise stage evaluation in order to choose the most effective treatment. In recent years, new and promising technologies have been proposed and are now available in daily practice. Each rectal cancer patient should be considered individually, choosing the diagnostic pretreatment exams that are appropriate for that single clinical case mainly related to the tumor and the available instruments. Clinicians must be informed about the efficacy of these technologies and be aware of any cause of mistake in tumor staging in order to reduce the risk of both improper use and inaccurate staging.
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Affiliation(s)
- F Rovera
- Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy.
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Rovera F, Dionigi G, Iosca S, Carrafiello G, Recaldini C, Boni L, Carcano G, Diurni M, Dionigi R. Preoperative assessment of rectal cancer stage: state of the art. Expert Rev Med Devices 2007; 4:517-22. [PMID: 17605687 DOI: 10.1586/17434440.4.4.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rectal cancer is one of the most common tumors worldwide; it accounts for approximately 25-30% of cancers arising in the large bowel. Owing to greater distribution of screening programs and better attention from both patients and General Practitioners to this disease, in recent years we have observed an increasing number of cases diagnosed in the early stages, with a consequent better prognosis. The improved 5-year survival is also partially due to better, and more accurate, diagnostic techniques and to more curative treatments. In this review, the authors analyze and discuss the more recent diagnostic techniques for an accurate preoperative staging of rectal cancer, highlighting each method's advantages and limits for their routine use in clinical practice.
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Affiliation(s)
- Francesca Rovera
- Clinical Lecturer, Department of Surgical Sciences, University of Insubria, Azienda Ospedaliero-Universitaria, Fondazione Macchi, Viale Borri 57, 21100 Varese, Italy.
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