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

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

Surgical Anatomy of the Extraorganic Anastomoses of the Middle Rectal Artery

Objective: to determine the topography variants and quantity of the extraorganic anastomoses of the middle rectal artery.Material and methods. 206 cadavers of males (aged 22-82) and 113 cadavers of females (aged 32-93) who had died of accidental causes not related to pelvic pathology were used as the research material. The vascular injection, preparation methods, and statistical analysis of the obtained data were used to achieve the aim of the research.Results. It has been found out that most often the extraorganic anastomoses of the middle rectal artery are formed in the proximal and middle thirds of the artery, significantly rarely - in its distal third. A linear correlation between the sizes of the diameters of the internal pudendal artery and the sizes of the diameters of its extraorganic anastomoses has been detected in the males and females.Conclusion. The performed research has demonstrated that the extraorganic anastomoses of the middle rectal artery in males and females have a definite pattern of origination.

Rectal Arteriovenous Malformation Treated by Transcatheter Arterial Embolization

An 86-year-old man who presented with frequent hematochezia with mild anemia on blood tests was admitted to our hospital. Colonoscopy exhibited a submucosal tumor-like lesion in the lower rectum. CT and MRI showed blood flow into the lesion, but not tumor component. Angiography of the superior rectal artery and left internal iliac artery showed vascular hyperplasia and nidus. Thus, rectal arteriovenous malformation was diagnosed. If bleeding from arteriovenous malformation was out of control, surgical resection was necessary. However, due to the age of the patient, we performed transcatheter arterial embolization and abdominoperineal resection was not needed. Embolization from the left superior rectal artery, middle rectal artery and inferior rectal artery was performed to control the bleeding and to avoid surgery. After embolization, he was followed up for 10 months in our hospital without recurrence.

Management of hydroureteronephrosis secondary to an aberrant middle rectal artery in a patient with congenital unilateral renal agenesis

Presented here is the case of a 21-year-old man, with a family history of unilateral renal agenesis, who presented with obstruction of his solitary functioning right kidney. Initially thought to be secondary to an obturator fossa hernia on endoscopic and retrograde pyelography assessment, diagnosis of obstruction secondary to an aberrant middle rectal artery was determined at laparotomy and division of this vessel relieved the patient’s obstruction without any short-term or long-term complications. To the best of the authors’ knowledge, this is the first reported case in the literature of hydroureteronephrosis secondary to an aberrant middle rectal artery.

Surgical Importance of Middle Rectal Artery

Background Middle rectal artery is one of the important arteries supplying the rectum, along with the superior and inferior rectal arteries. Study of middle rectal artery was undertaken as it is important in surgeries of rectal carcinoma. Materials and Methods For the present study, 40 pelvises, fixed in 10% formalin, were procured from the Department of Anatomy of Dr. D. Y. Patil Medical College, Pune, Maharashtra, India. Sagittal section of pelvis was taken and dissection was performed following the steps according to the Cunningham’s manual. Results Variations were found in the origin of middle rectal artery such as those arising from the internal pudendal artery in nine cases. In two cases, it was arising from the common stem of internal pudendal and inferior gluteal arteries. It was seen arising from the inferior vesical artery in one case, while in two cases the middle rectal artery was arising from the obturator artery. Conclusion This is the artery that penetrates the fascia of the rectum which is important in mesorectal excision in cases of rectal carcinoma. It forms anastomosis with superior rectal artery. In low anterior resection of rectum, the middle rectal artery is always exposed.

Individual features of blood supply and lateral metastasis of colorectal cancer

One of the main causes of local recurrence of rectal cancer is the regional lymphatic nodes metastasis. Existing methods of staging does not have absolute sensitivity and specificity with regard to lesion of regional lymphatic nodes in general, and of lateral group in particular. It is necessary to look for new methods of diagnosis, to identify risk factors and unfavorable prognosis of lateral metastasis in colorectal cancer, which will provide a more differentiated approach to the choice of treatment policy, indications for neoadjuvant chemoradiotherapy and/or lymphatic node dissection. The work on the two groups of patients (control and basic) was performed on the basis of CT performed in angio mode and MRI investigated anatomical variability of middle rectal arteries, proved its impermanence, and studied the relationship between presence of the middle rectal artery and lesion of regional lymphatic nodes in rectal cancer. Prognostic risk factors for lateral metastasis in rectal cancer were proposed, comparative analysis techniques allowing for visualization of the middle rectal vessels was performed.