The Current Status of Nodal Staging in Rectal Cancer

Lord, Amy; D’Souza, Nigel; Shaw, Annabel; Day, Nigel; Brown, Gina

doi:10.1007/s11888-019-00441-3

Cited by 11 publications

(8 citation statements)

References 31 publications

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“…The results justify this approach as no patients had a higher T-stage tumour than had been demonstrated in their imaging at diagnosis, conversely 30% of patients were downstaged. Lymph node status was more variable but has previously been demonstrated to offer little prognostic value [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Experiences of a “COVID protected” robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic

et al. 2021

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The recent COVID-19 pandemic led to the cancellation of elective surgery across the United Kingdom. Re-establishing elective surgery in a manner that ensures patient and staff safety has been a priority. We report our experience and patient outcomes from setting up a “COVID protected” robotic unit for colorectal and renal surgery that housed both the da Vinci Si (Intuitive, Sunnyvale, CA, USA) and the Versius (CMR Surgical, Cambridge, UK) robotic systems. “COVID protected” robotic surgery was undertaken in a day-surgical unit attached to the main hospital. A standard operating procedure was developed in collaboration with the trust COVID-19 leadership team and adapted to national recommendations. 60 patients underwent elective robotic surgery in the initial 10-weeks of the study. This included 10 colorectal procedures and 50 urology procedures. Median length of stay was 4 days for rectal cancer procedures, 2 days less than prior to the COVID period, and 1 day for renal procedures. There were no instances of in-patient coronavirus transmission. Six rectal cancer patients waited more than 62 days for their surgery because of the initial COVID peak but none had an increase T-stage between pre-operative staging and post-operative histology. Robotic surgery can be undertaken in “COVID protected” units within acute hospitals in a safe way that mitigates the increased risk of undergoing major surgery in the current pandemic. Some benefits were seen such as reduced length of stay for colorectal patients that may be associated with having a dedicated unit for elective robotic surgical services.

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Section: Discussionmentioning

confidence: 99%

Experiences of a “COVID protected” robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic

et al. 2021

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“…One issue that deserves attention is the presence of tumor deposits (TDs), which are usually identified under microscope by the pathologist. TDs are defined as nodules within the mesorectum that contain carcinoma cells without the obvious structure of a lymph node [ 27 ]. In one of our cases, TDs were observed on imaging exams and included in the group of suspect LNs (Case No.…”

Section: Discussionmentioning

confidence: 99%

Synchronous Colorectal Cancer: Improving Accuracy of Detection and Analyzing Molecular Heterogeneity—The Main Keys for Optimal Approach

et al. 2021

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Background: In patients with synchronous colorectal cancer (SCRC), understanding the underlying molecular behavior of such cases is mandatory for designing individualized therapy. The aim of this paper is to highlight the importance of transdisciplinary evaluation of the pre- and post-operative assessment of patients with SCRCs, from imaging to molecular investigations. Methods: Six patients with SCRCs presented with two carcinomas each. In addition to the microsatellite status (MSS), the epithelial mesenchymal transition was checked in each tumor using the biomarkers β-catenin and E-cadherin, same as KRAS and BRAF mutations. Results: In two of the patients, the second tumor was missed at endoscopy, but diagnosed by a subsequent computed-tomography-scan (CT-scan). From the six patients, a total of 11 adenocarcinomas (ADKs) and one squamous cell carcinoma (SCC) were analyzed. All the examined carcinomas were BRAF-wildtype microsatellite stable tumors with an epithelial histological subtype. In two of the six cases, KRAS gene status showed discordance between the two synchronous tumors, with mutations in the index tumors and wildtype status in the companion ones. Conclusions: Preoperative CT-scans can be useful for detection of synchronous tumors which may be missed by colonoscopy. Where synchronous tumors are identified, therapy should be based on the molecular profile of the indexed tumors.

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“…Tumour deposits are found in 3.3% of rectal cancer specimens without lymph node involvement, in which case N1c should be recorded (TNM classification), but when lymph nodes are positive, tumour deposits are not to be added to the total positive lymph node count. Lord et al are currently studying the differentiation of extranodal tumour deposits (mrENTDs) from involved lymph nodes on MR imaging-the subject of an ongoing clinical trial named COMET [59]. Their imaging definition is quite different from the pathologic definition described above [59].…”

Section: Lymph Node Involvement and Tumour Depositsmentioning

confidence: 99%

“…Lord et al are currently studying the differentiation of extranodal tumour deposits (mrENTDs) from involved lymph nodes on MR imaging-the subject of an ongoing clinical trial named COMET [59]. Their imaging definition is quite different from the pathologic definition described above [59]. mr-ENTDs are described as comet-shaped nodules of tumour which appear to directly interrupt the course of a vein (Fig.…”

Section: Lymph Node Involvement and Tumour Depositsmentioning

confidence: 99%

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MRI of rectal cancer—relevant anatomy and staging key points

et al. 2020

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Rectal cancer has the eighth highest cancer incidence worldwide, and it is increasing in young individuals. However, in countries with a high human development index, mortality is decreasing, which may reflect better patient management, imaging being key. We rely on imaging to establish the great majority of clinical tumour features for therapeutic decision-making, namely tumour location, depth of invasion, lymph node involvement, circumferential resection margin status and extramural venous invasion. Despite major improvements in technique resulting in better image quality, and notwithstanding the dissemination of guidelines and examples of standardised reports, rectal cancer staging is still challenging on the day-today practice, and we believe there are three reasons. First, the normal posterior pelvic compartment anatomy and variants are not common knowledge to radiologists; second, not all rectal cancers fit in review paper models, namely the very early, the very low and the mucinous; and third, the key clinical tumour features may be tricky to analyse. In this review, we discuss the normal anatomy of the rectum and posterior compartment of the pelvis, systematise all rectal cancer staging key points and elaborate on the particularities of early, low and mucinous tumours. We also include our suggested reporting templates and a discussion of its comparison to the reporting templates provided by ESGAR and SAR.

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The Current Status of Nodal Staging in Rectal Cancer

Cited by 11 publications

References 31 publications

Experiences of a “COVID protected” robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic

Experiences of a “COVID protected” robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic

Synchronous Colorectal Cancer: Improving Accuracy of Detection and Analyzing Molecular Heterogeneity—The Main Keys for Optimal Approach

MRI of rectal cancer—relevant anatomy and staging key points

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