MRI Predictive Factors for Long-Term Outcomes of Low Rectal Tumours

Shihab, Oliver C.; Taylor, Fiona; Salerno, Gisella; Heald, R. J.; Quirke, Philip; Moran, Brendan; Brown, Gina

doi:10.1245/s10434-011-1776-2

Cited by 74 publications

(63 citation statements)

References 19 publications

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“…However, the surgical management of rectal cancer has evolved over the recent years with the acceptance of the principle of total mesorectal excision (TME) and the recognition of the importance of a clear surgical resection and avoidance of tumor perforation during an APE (7). This procedure has evolved into the extra levator abdominoperineal excision (eLAPE) with the potential surgical resection margin information being identified through MRI staging (7, 8). This has resulted in a reduction in circumferential resection margin involvement and intra-operative perforation of the tumor (9).…”

Section: Introductionmentioning

confidence: 99%

Repair of Perineal Hernia Following Abdominoperineal Excision with Biological Mesh: A Systematic Review

et al. 2016

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IntroductionPerineal hernia (PerH) following abdominoperineal excision (APE) procedure is a recognized complication. PerH was considered an infrequent complication of APE procedure; however, PerH rates of up to 45% have been reported in recent publications following a laparoscopic APE procedure. Various methods of repair of PerH with the use of synthetic meshes or myocutaneous flap have been described, although there is no general agreement on an optimal strategy. The use of biological meshes for different operations is growing in popularity, and these have been promoted as being superior and safer when compared to synthetic meshes. Although the use of biologics is becoming popular claims of better outcomes are largely unsupported by evidence. The aim of this systematic review is to evaluate the currently available evidence supporting the use of biologic or biosynthetic meshes for the repair of PerH that develop following an APE.MethodsA systematic review of all English language literature relevant to repair of PerH following APE with biologic or biosynthetic mesh published between January 1, 2000 and July 31, 2016 was carried out using MEDLINE, EMBASE, and the Cochrane Library of Systematic Reviews for relevant literature. Searches were performed using a combination of Medical Subject Headings (MeSH) terms and text words “PerH,” “APE,” “morbidity,” “biologics,” “biosynthetic,” and “hernia.” Studies in which the use of biological meshes was not reported were excluded from the review. Various outcome measures, including operative technique, complication rates, recurrence rates, type of mesh, management of recurrences, and risk factors, were extracted. Oxford Centre for Evidence-based Medicine – Levels of Evidence (March 2009) was used to assess the quality of evidence.ResultsThe systematic review of the literature identified three case reports, four case series, and one pooled analysis that were included in the final review. Overall, these studies were of poor quality providing level 4 evidence. Various different approaches and techniques of repair of PerH were described; however, it was difficult to extract information with regard to the primary and secondary outcome measures.ConclusionThere is no general agreement to the optimal operative strategy to repair PerH following an APE. There is insufficient evidence to recommend any specific operative approach or repair technique for PerH following an APE.

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Section: Introductionmentioning

confidence: 99%

Repair of Perineal Hernia Following Abdominoperineal Excision with Biological Mesh: A Systematic Review

et al. 2016

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“…[12][13][14] Low location has also been associated with decreased MR accuracy, 15,16 but more recently, MR tumor regression grade was associated with reduced local recurrence. 17 In summary, MR has very good overall accuracy for predicting mesorectal margin involvement and local recurrence, but perhaps slightly less accuracy for anterior and low tumor location.…”

Section: Discussionmentioning

confidence: 93%

Accuracy of Endorectal Ultrasound for Measurement of the Closest Predicted Radial Mesorectal Margin for Rectal Cancer

Phang

Gollub²,

Loh³

et al. 2012

Diseases of the Colon &Amp; Rectum

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“…6). In kürzlich veröffentlichten Studien [70] konnte dieser MRT-Tumorregressionsgrad sogar als ein weiterer prognostischer Faktor vor allem bei tief sitzenden Tumoren signifikant herausgestellt werden. Aktuelle Studien zeigen bei der Bestimmung des Abstands vom Tumorrand zur mesorektalen Faszie mittels MRT nach Radiochemotherapie einen hohen negativen Vorhersagewert von bis zu 100 %.…”

Section: Tief Sitzendes Rektumkarzinomunclassified

Aktuelle MRT-Diagnostik des Rektumkarzinoms

Wietek

Kratt

2012

Fortschr Röntgenstr

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Colorectal carcinoma is the second most prevalent cause for cancer, and has very variable outcomes. Advancements in surgery, the change from adjuvant to neo-adjuvant radio-chemo-therapies as well as in clinical diagnostics have improved the prognosis for patients in a multi-modal therapy concept. An accurate primary staging including a reliable prediction of the circumferential resection margin (CRM) has established MR Imaging (MRI) beside intraluminal endoscopic ultrasound (EUS). MRI facilitates the selection of patients likely to benefit from a preoperative therapy, especially in cases of unfavorable factors. Currently the relationship of the tumor to the mesorectal fascia has become a more important prognostic factor than the T-staging, particularly for surgical therapy. In addition further prognostic factors like the depth of infiltration into the perirectal fat and the extramural venous infiltration (EMVI) have important impact on therapy and prognosis. High resolution MRI has proved useful in clarifying the relationship between the tumor and the mesorectal fascia, which represents the CRM at the total mesorectal excision (TME) especially in the upper and middle third. Preoperative evaluation of the other prognostic factors as well as the nodal status is still difficult. It is used increasingly not only for primary staging but also progressively for the monitoring of neoadjuvant therapy. The addition of diffusion weighted imaging (DWI) is an interesting option for the improvement of response evaluation. The following overview provides an introduction of MRI diagnosis as well as its importance for the evaluation of the clinically relevant prognostic factors leading to an improvement of therapy and prognosis of patients with rectal carcinoma.

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MRI Predictive Factors for Long-Term Outcomes of Low Rectal Tumours

Cited by 74 publications

References 19 publications

Repair of Perineal Hernia Following Abdominoperineal Excision with Biological Mesh: A Systematic Review

Repair of Perineal Hernia Following Abdominoperineal Excision with Biological Mesh: A Systematic Review

Accuracy of Endorectal Ultrasound for Measurement of the Closest Predicted Radial Mesorectal Margin for Rectal Cancer

Aktuelle MRT-Diagnostik des Rektumkarzinoms

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