The middle rectal artery detected by contrast-enhanced magnetic resonance imaging predicts lateral lymph node metastasis in lower rectal cancer

Abstract

Purpose Lateral lymph node (LLN) metastasis is one of the leading causes of local recurrence in patients with lower rectal cancer. Unfortunately, no diagnostic biomarkers are currently available that can predict LLN metastasis preoperatively. Accordingly, we investigated the relationship between the middle rectal artery (MRA) identified by contrast-enhanced magnetic resonance imaging (ceMRI) and LLN metastases. Methods Data from 102 patients with lower rectal cancer who underwent surgery, and were evaluated by preoperative ceMRI, between 2008 and 2016 were reviewed retrospectively. Two expert radiologists evaluated the MRA findings. The diagnostic performance of MRA for LLN metastasis was evaluated by a multivariate analysis with conventional clinicopathological factors. Results The MRA was detected in 67 patients (65.7%), including 32 (31.4%) with bilateral MRA and 35 (34.3%) with unilateral MRA. The tumor size, presence of the MRA, and clinical LLN status were significantly correlated with LLN metastasis. A multivariate analysis demonstrated that the presence of MRA (P = 0.045) and clinical LLN status (P = 0.001) were independent predictive factors for LLN metastasis. Furthermore, the sensitivity and negative predictive value of MRA for LLN metastasis were 95% and 97.1%, respectively. Conclusion We successfully demonstrated that MRAs could be clearly detected by ceMRI, and the presence of MRA robustly predicted LLN metastasis in patients with lower rectal cancer, highlighting its clinical significance in the selection of more appropriate treatment strategies. Trial registration Trial registration number: retrospectively registered 2126 Trial registration date of registration: August 23, 2019

The middle anorectal artery: A systematic review and meta‐analysis of 880 patients/1905 pelvic sides

“…There are studies in which the vessel was not found in any cases (Aigner et al, 2004; Schuurman et al, 2009), as well those that report its presence in all the cases studied (Adachi, 1928; Havenga et al, 1996; Ishii et al, 2018; Wei & Xiaoming, 2020). Similar prevalence of the MAA to the PPE of the current meta‐analysis was noted by DiDio et al (1986), Iwasa et al (2021), Jones et al (1999), Roberts and Krishingner (1967), Shafik and Mostafa (1996), and Widmer (1955). More detailed results on the prevalence of the MAA in the included studies can be found in Table 1.…”

“…Having removed duplicates ( n = 66), 449 records were screened against the inclusion and exclusion criteria, based on their title and abstract. A full text analysis was undertaken on 105 potentially eligible studies, leading to identification of 28 works that were included in this systematic review and meta‐analysis (Adachi, 1928; Aigner et al, 2004; Ayoub, 1978; Bilhim et al, 2013; Boxall et al, 1963; DiDio et al, 1986; Drummond, 1914; Havenga et al, 1996; Ishii et al, 2018; Iwasa et al, 2021; Jiang et al, 2006; Jones et al, 1999; Lin et al, 2010; Lipshutz, 1918; Muntean, 1999; Naguib et al, 2008; Naidoo et al, 2018; Nano et al, 1998, 2000; Parsons & Keith, 1897; Roberts & Krishingner, 1967; Sato & Sato, 1991; Schuurman et al, 2009; Shafik & Mostafa, 1996; Vogel & Klosterhalfen, 1988; Wei & Xiaoming, 2020; Widmer, 1955; Zhang et al, 2010).…”

The Middle Rectal Artery: Revisited Anatomy and Surgical Implications of a Neglected Blood Vessel

“…3,8 However, a very recent study using contrast-enhanced MRI in 102 individuals reported the presence of the MRA in a similar percentage of cases (65.7%) as in our investigation (71.4%). 19…”

“…This correlation emphasizes not only the key role of the MRA for lateral tumor spread but also the clinical significance of the MRA in the selection of tailored treatment regimens. 19…”

“…3,8 However, a very recent study using contrast-enhanced MRI in 102 individuals reported the presence of the MRA in a similar percentage of cases (65.7%) as in our investigation (71.4%). 19 5. Laterality: in our series, the MRA was detected unilaterally in one half of cases and bilaterally in 21.4%.…”