Factors related to preoperative assessment of the circumferential resection margin and the extent of mesorectal invasion by magnetic resonance imaging in rectal cancer: a prospective comparison study.
BACKGROUND
This study was designed to identify factors related to inaccurate prediction of circumferential resection margin (CRM) and the extent of mesorectal invasion (EMI) in T3 tumors by preoperative magnetic resonance imaging (MRI) in rectal cancer.


METHODS
A total of 66 patients with rectal cancer were enrolled prospectively in this study. CRM was defined as the distance from the outer tumor margin to the mesorectal fascia, and EMI was defined as the distance from the outer surface of the muscularis propria to the outermost tumor margin. CRM and EMI measurements on MRI were compared with corresponding measurements from whole-mount sections using 1-mm and 5-mm reference values, respectively, as prognostic indicators. The following variables were analyzed for relevance to preoperative staging: tumor distance from the anal verge (lower and middle), tumor location (anterior and posterior), tumor (T) and nodal (N) stage, and the thickness of the perirectal fat (anterior, left, right, and posterior positions).


RESULTS
MRI correctly predicted CRM status in 57 of the 66 tumors and EMI status in 51 of the 58 tumors (eight T1 tumors were excluded from EMI analysis). Univariate analysis showed that T3 stage, lymph node involvement, anterior tumor location, and thin perirectal fat thickness at the anterior portion were related to incorrect prediction of CRM. Anterior tumor location and thin perirectal fat thickness at the anterior portion were related to incorrect prediction of EMI.


CONCLUSIONS
Preoperative chemoradiation can be accurately guided by preoperative MRI staging, but CRM and EMI in anterior rectal tumor should be interpreted with caution.
Kim
Young-Wan
YW
Department of Surgery, Yonsei University College of Medicine, 134 Shinchon-Dong, Seodaemun-Ku, Seoul, 120-752, Korea. wow0313@hanmail.net
Cha
Seung-Whan
SW
Pyo
Juyon
J
Kim
Nam-Kyu
NK
Min
Byung-Soh
BS
Kim
Myeong-Jin
MJ
Kim
Hoguen
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery