Preoperative Staging of Rectal Cancer: The MERCURY Research Project

2005 ◽  
pp. 58-74 ◽  
Author(s):  
G. Brown ◽  
I. R. Daniels
Keyword(s):  
Rectal Cancer ◽  
Preoperative Staging ◽  
Research Project

scholarly journals Influence of incorrect staging of colorectal carcinoma on oncological outcome: are we playing safely?

2021 ◽  
Author(s):  
Claudia Reali ◽  
Gabriele Bocca ◽  
Ian Lindsey ◽  
Oliver Jones ◽  
Chris Cunningham ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Preoperative Staging ◽  
Neoadjuvant Treatment ◽  
Preoperative Imaging ◽  
Resection Margins ◽  
Colorectal Cancers ◽  
Radiological Staging ◽  
N Stage

AbstractAccurate preoperative staging of colorectal cancers is critical in selecting patients for neoadjuvant therapy prior to resection. Inaccurate staging, particularly understaging, may lead to involved resection margins and poor oncological outcomes. Our aim is to determine preoperative imaging accuracy of colorectal cancers compared to histopathology and define the effect of inaccurate staging on patient selection for neoadjuvant treatment(NT). Staging and treatment were determined for patients undergoing colorectal resections for adenocarcinomas in a single tertiary centre(2016–2020). Data were obtained for 948 patients. The staging was correct for both T and N stage in 19.68% of colon cancer patients. T stage was under-staged in 18.58%. At resection, 23 patients (3.36%) had involved pathological margins; only 7 of which had been predicted by pre-operative staging. However, the staging was correct for both T and N stage in 53.85% of rectal cancer patients. T stage was understaged in 26.89%. Thirteen patients had involved(R1)margins; T4 had been accurately predicted in all of these cases. There was a general trend in understaging both the tumor and lymphonodal involvement (T p < 0.00001 N p < 0.00001) causing a failure in administrating NT in 0.1% of patients with colon tumor, but not with rectal cancer. Preoperative radiological staging tended to understage both colonic and rectal cancers. In colonic tumours this may lead to a misled opportunity to treat with neoadjuvant therapy, resulting in involved margins at resection.

How accurate is endorectal ultrasound in the preoperative staging of rectal cancer?

1993 ◽  
Vol 36 (2) ◽  
pp. 127-134 ◽  
Author(s):  
U. Herzog ◽  
M. von Flüe ◽  
P. Tondelli ◽  
J. P. Schuppisser
Keyword(s):  
Rectal Cancer ◽  
Preoperative Staging ◽  
Endorectal Ultrasound

A nomogram based on clinical factors to predict locally advanced stage of rectal cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 376-376
Author(s):  
Guoxiang Cai ◽  
Baorong Song ◽  
Liyong Huang ◽  
Ye Xu ◽  
Zuqing Guan ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Locally Advanced ◽  
Preoperative Staging ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Neoadjuvant Radiochemotherapy ◽  
Advanced Stage ◽  
Serum Cea ◽  
Magnetic Resonance Imaging Mri

376 Background: Preoperative staging of rectal cancer is important for designing treatment strategy. The standard treatment for locally advanced rectal cancer is neoadjuvant radiochemotherapy followed by surgery. Magnetic resonance imaging (MRI) and transrectal ultrasonography are major staging approaches with a prediction accuracy of about 70-80% but not widely available in hospitals in China. We sought to define possible clinicopathological predictors and establish a simple nomogram as a reference tool for patients and clinicians to predict stage of rectal cancer and make decisions about neoadjuvant therapy. Methods: Preoperative staging of rectal cancer is important for designing treatment strategy. The standard treatment for locally advanced rectal cancer is neoadjuvant radiochemotherapy followed by surgery. Magnetic resonance imaging (MRI) and transrectal ultrasonography are major staging approaches with a prediction accuracy of about 70-80% but not widely available in hospitals in China. We sought to define possible clinicopathological predictors and establish a simple nomogram as a reference tool for patients and clinicians to predict stage of rectal cancer and make decisions about neoadjuvant therapy. Results: In the training set, 77.1% of patients had locally advanced stage by pathology. The multivariate analysis indicated that tumor size (Odds ratio (OR)=1.55, p< 0.001), differentiation (OR =0.38, p< 0.001), location (OR =1.06, p=0.038), serum CEA (OR =0.24, p< 0.001) and CA19-9 level (OR =0.13, p< 0.001) were associated with tumor stage. A nomogram consisting of these 5 factors was developed and predicted locally advanced stage with a concordance index of 0.756. The concordance index of this nomogram was 0.800 in the validation set. Conclusions: Large tumor size, far from anal verge, poor differentiation, elevated serum CEA and CA19-9 level were high-risk factors of locally advanced stage of rectal cancer. The nomogram based on these clinical factors can predicte locally advanced rectal cancer with a considerable accuracy and thus helpful for making neoadjuvant therapy recommendations.

Neoadjuvant chemoradiotherapy for locally advanced rectal cancer: Predicting long-term outcomes based on response to treatment.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 621-621
Author(s):  
Kirsten Elizabeth Jean Laws ◽  
Christina Wilson ◽  
David McIntosh ◽  
Stephen Harrow
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Preoperative Staging ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Combined Modality Treatment ◽  
Long Term Outcomes ◽  
Node Positive ◽  
Long Course

621 Background: Neoadjuvant long course chemoradiotherapy is well recognised as a standard treatment in locally advanced, margin threatening rectal cancer, in order to downstage and reduce local recurrence. We investigated retrospectively whether long term outcomes could be predicted by response to neoadjuvant treatment, and which factors specifically seemed to predict a risk of poorer outcome. Methods: All patients treated with long course chemoradiotherapy between January 2008 and December 2009 were identified retrospectively. Patients were excluded if the treatment indication was for inoperable disease, postoperative, recurrence, or palliative intent. A total of 231 patients were analysed with retrospective analysis of all electronic records and case notes. The following information was collated: preoperative staging, chemoradiotherapy treatment planned and received, operation performed, postoperative pathology (including nodal status, margins, presence of LVSI, and evidence of response to neoadjuvant treatment), disease free survival, and overall survival. Results: Kaplan Meier curves are presented showing patients with either a complete or partial response to neoadjuvant treatment appear to have a statistically significant improvement in long term outcomes, compared to those with no response (Mean survival 55 months, 56 months and 43months respectively, p<0.01). Furthermore, those who remain node positive or have evidence of LVSI following neoadjuvant treatment appear to have a statistically significant poorer outcome. Conclusions: Our study further develops on previous work looking at the prediction of outcomes following response to neoadjuvant treatment in rectal cancer. It appears that those who respond to initial treatment will have a better outcome than those who do not, including those who remain node positive or with LVSI following treatment. This study is limited because it is retrospective. Randomised controlled trial data is required to enable identification of poor risk imaging and pathology features that might suggest the need for adjuvant therapy following combined modality treatment with neoadjuvant chemoradiotherapy and surgery.

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