Magnetic resonance tumour regression grade and pathological correlates in patients with rectal cancer.
Published: 12th June 2018
Authors: J. K. Jang, J. L. Lee, S. H. Park, H. J. Park, I. J. Park, J. H. Kim et al.
Evidence to support the specific use of magnetic resonance tumour regression grade (mrTRG) is inadequate. The aim of this study was to investigate the pathological characteristics of mrTRG after chemoradiotherapy (CRT) for rectal cancer and the implications for surgery.
Patients undergoing long‐course CRT (45–50 Gy plus a booster dose of 4–6 Gy) for mid or low rectal cancer (cT3−4 or cN+ without metastasis) between 2011 and 2015 who had post‐CRT rectal MRI before surgery were included retrospectively. Three board‐certified experienced radiologists assessed mrTRG. mrTRG was correlated with pathological tumour regression grade (pTRG), ypT and ypN. In a subgroup of patients with mrTRG1−2 and no tumour spread (such as nodal metastasis) on MRI, the projected rate of completion total mesorectal excision (TME) if they underwent transanal excision (TAE) and had a ypT status of ypT2 or higher was estimated, and recurrence‐free survival was calculated according to the operation (TME or TAE) that patients had actually received.
Some 439 patients (290 men and 149 women of mean(s.d.) age 62·2(11·4) years) were analysed. The accuracy of mrTRG1 for predicting pTRG1 was 61 per cent (40 of 66), and that for ypT1 or less was 74 per cent (49 of 66). For mrTRG2, these values were 22·3 per cent (25 of 112) and 36·6 per cent (41 of 112) respectively. Patients with mrTRG1 and mrTRG2 without tumour spread were ypN+ in 3 per cent (1 of 29) and 16 per cent (8 of 50) respectively. Assuming mrTRG1 or mrTRG1−2 with no tumour spread on post‐CRT MRI as the criteria for TAE, the projected completion TME rate was 26 per cent (11 of 43) and 41·0 per cent (41 of 100) respectively. For the 100 patients with mrTRG1–2 and no tumour spread, recurrence‐free survival did not differ significantly between TME (79 patients) and TAE (21) (adjusted hazard ratio 1·86, 95 per cent c.i. 0·42 to 8·18).
Patients with mrTRG1 without tumour spread may be suitable for TAE.Full text
You may also be interested in
Meta‐analysis of in‐hospital delay before surgery as a risk factor for complications in patients with acute appendicitis. BJS 2018; 105: 933-945.
Authors: S. T. van Dijk, A. H. van Dijk, M. G. Dijkgraaf, M. A. Boermeester
Notes: Delay is safe
Long‐term prognostic impact of surgical complications in the German Rectal Cancer Trial CAO/ARO/AIO‐94.
Authors: T. Sprenger, T. Beißbarth, R. Sauer, J. Tschmelitsch, R. Fietkau, T. Liersch et al.
Notes: Morbidity matters
Oncological outcome after MRI‐based selection for neoadjuvant chemoradiotherapy in the OCUM Rectal Cancer Trial.
Authors: R. Ruppert, T. Junginger, H. Ptok, J. Strassburg, C. A. Maurer, P. Brosi et al.
Notes: Limiting radiotherapy appears safe.
Randomized clinical trial
Randomized clinical trial of elective resection versus observation in diverticulitis with extraluminal air or abscess initially managed conservatively. BJS 2018; 105: 971-979.
Authors: K. You, R. Bendl, C. Taut, R. Sullivan, M. Gachabayov, R. Bergamaschi et al.
Notes: Conservative management appropriate
Authors: E. Duchalais, T. Glyn Mullaney, G. M. Spears, S. R. Kelley, K. Mathis, W. S. Harmsen et al.
Notes: Post‐treatment T stage predicts prognosis
Nationwide trends in the incidence and outcome of patients with gastrointestinal stromal tumour in the imatinib era. BJS 2018; 105: 1020-1027.
Authors: W. T. A. van der Graaf, R. Tielen, J. J. Bonenkamp, V. Lemmens, R. H. A. Verhoeven, J. H. W. de Wilt et al.
Notes: Surgery improves survival
Prognostic impact of perihepatic lymph node metastases in patients with resectable colorectal liver metastases.
Authors: M. Okuno, C. Goumard, T. Mizuno, S. Kopetz, K. Omichi, C.‐W. D. Tzeng et al.
Notes: Bad sign of advanced disease
Novel de novo synthesized phosphate carrier compound ABA‐PEG20k‐Pi20 suppresses collagenase production in Enterococcus faecalis and prevents colonic anastomotic leak in an experimental model.
Authors: M. Wiegerinck, S. K. Hyoju, J. Mao, A. Zaborin, C. Adriaansens, E. Salzman et al.
Notes: Further evidence the microbiome may be important
Systematic review of the influence of socioeconomic deprivation on mortality after colorectal surgery. BJS 2018; 105: 959-970.
Authors: T. E. Poulton, T. Salih, P. Martin, A. Rojas‐Garcia, R. Raine, S. R. Moonesinghe et al.
Notes: Major differences in mortality
Two‐year results of the randomized clinical trial DILALA comparing laparoscopic lavage with resection as treatment for perforated diverticulitis.
Authors: A. Kohl, J. Rosenberg, D. Bock, T. Bisgaard, S. Skullman, A. Thornell et al.
Notes: Laparoscopic lavage still an option
Authors: F. Ris, E. Liot, N. C. Buchs, R. Kraus, G. Ismael, V. Belfontali et al.
Notes: Appears to reduce leaks
Hyperactive cyclic motor activity in the distal colon after colonic surgery as defined by high‐resolution colonic manometry. BJS 2018; 105: 907-917.
Authors: R. Vather, G. O'Grady, A. Y. Lin, P. Du, C. I. Wells, D. Rowbotham et al.
Notes: May contribute to gut dysfunction