Postoperative MRI Findings Following Conventional and Extralevator Abdominoperineal Excision in Low Rectal Cancer

Aim: The disparity in outcomes for low rectal cancer may reflect differences in operative approach and quality. The extralevator abdominoperineal excision (ELAPE) was developed to reduce margin involvement in low rectal cancers by widening the excision of the conventional abdominoperineal excision (...

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Autores principales:	Kim Morgenstjerne Oerskov, Peter Bondeven, Søren Laurberg, Rikke H. Hagemann-Madsen, Henrik Kidmose Christensen, Henrik Lauridsen, Bodil Ginnerup Pedersen
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	rectal cancer magnetic resonance imaging extralevator abdominoperineal excision ELAPE APE Surgery RD1-811
Acceso en línea:	https://doaj.org/article/808d5d0054d6439c9684ffa6aa93152a
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spelling	oai:doaj.org-article:808d5d0054d6439c9684ffa6aa93152a2021-11-16T05:04:35ZPostoperative MRI Findings Following Conventional and Extralevator Abdominoperineal Excision in Low Rectal Cancer2296-875X10.3389/fsurg.2021.771107https://doaj.org/article/808d5d0054d6439c9684ffa6aa93152a2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fsurg.2021.771107/fullhttps://doaj.org/toc/2296-875XAim: The disparity in outcomes for low rectal cancer may reflect differences in operative approach and quality. The extralevator abdominoperineal excision (ELAPE) was developed to reduce margin involvement in low rectal cancers by widening the excision of the conventional abdominoperineal excision (c-APE) to include the posterior pelvic diaphragm. This study aimed to determine the prevalence and localization of inadvertent residual pelvic diaphragm on postoperative MRI after intended ELAPE and c-APE.Methods: A total of 147 patients treated with c-APE or ELAPE for rectal cancer were included. Postoperative MRI was performed on 51% of the cohort (n = 75) and evaluated with regard to the residual pelvic diaphragm by a radiologist trained in pelvic MRI. Patient records, histopathological reports, and standardized photographs were assessed. Pathology and MRI findings were evaluated independently in a blinded fashion. Additionally, preoperative MRIs were evaluated for possible risk factors for margin involvement.Results: Magnetic resonance imaging-detected residual pelvic diaphragm was identified in 45 (75.4%) of 61 patients who underwent ELAPE and in 14 (100%) of 14 patients who underwent c-APE. An increased risk of margin involvement was observed in anteriorly oriented tumors with 16 (22%) of 73 anteriorly oriented tumors presenting with margin involvement vs. 7 (9%) of 74 non-anteriorly oriented tumors (p = 0.038).Conclusion: Residual pelvic diaphragm following abdominoperineal excision can be depicted by postoperative MRI. Inadvertent residual pelvic diaphragm (RPD) was commonly found in the series of patients treated with the ELAPE technique. Anterior tumor orientation was a risk factor for circumferential resection margin (CRM) involvement regardless of surgical approach.Kim Morgenstjerne OerskovPeter BondevenSøren LaurbergSøren LaurbergRikke H. Hagemann-MadsenHenrik Kidmose ChristensenHenrik LauridsenBodil Ginnerup PedersenBodil Ginnerup PedersenFrontiers Media S.A.articlerectal cancermagnetic resonance imagingextralevator abdominoperineal excisionELAPEAPESurgeryRD1-811ENFrontiers in Surgery, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	rectal cancer magnetic resonance imaging extralevator abdominoperineal excision ELAPE APE Surgery RD1-811
spellingShingle	rectal cancer magnetic resonance imaging extralevator abdominoperineal excision ELAPE APE Surgery RD1-811 Kim Morgenstjerne Oerskov Peter Bondeven Søren Laurberg Søren Laurberg Rikke H. Hagemann-Madsen Henrik Kidmose Christensen Henrik Lauridsen Bodil Ginnerup Pedersen Bodil Ginnerup Pedersen Postoperative MRI Findings Following Conventional and Extralevator Abdominoperineal Excision in Low Rectal Cancer
description	Aim: The disparity in outcomes for low rectal cancer may reflect differences in operative approach and quality. The extralevator abdominoperineal excision (ELAPE) was developed to reduce margin involvement in low rectal cancers by widening the excision of the conventional abdominoperineal excision (c-APE) to include the posterior pelvic diaphragm. This study aimed to determine the prevalence and localization of inadvertent residual pelvic diaphragm on postoperative MRI after intended ELAPE and c-APE.Methods: A total of 147 patients treated with c-APE or ELAPE for rectal cancer were included. Postoperative MRI was performed on 51% of the cohort (n = 75) and evaluated with regard to the residual pelvic diaphragm by a radiologist trained in pelvic MRI. Patient records, histopathological reports, and standardized photographs were assessed. Pathology and MRI findings were evaluated independently in a blinded fashion. Additionally, preoperative MRIs were evaluated for possible risk factors for margin involvement.Results: Magnetic resonance imaging-detected residual pelvic diaphragm was identified in 45 (75.4%) of 61 patients who underwent ELAPE and in 14 (100%) of 14 patients who underwent c-APE. An increased risk of margin involvement was observed in anteriorly oriented tumors with 16 (22%) of 73 anteriorly oriented tumors presenting with margin involvement vs. 7 (9%) of 74 non-anteriorly oriented tumors (p = 0.038).Conclusion: Residual pelvic diaphragm following abdominoperineal excision can be depicted by postoperative MRI. Inadvertent residual pelvic diaphragm (RPD) was commonly found in the series of patients treated with the ELAPE technique. Anterior tumor orientation was a risk factor for circumferential resection margin (CRM) involvement regardless of surgical approach.
format	article
author	Kim Morgenstjerne Oerskov Peter Bondeven Søren Laurberg Søren Laurberg Rikke H. Hagemann-Madsen Henrik Kidmose Christensen Henrik Lauridsen Bodil Ginnerup Pedersen Bodil Ginnerup Pedersen
author_facet	Kim Morgenstjerne Oerskov Peter Bondeven Søren Laurberg Søren Laurberg Rikke H. Hagemann-Madsen Henrik Kidmose Christensen Henrik Lauridsen Bodil Ginnerup Pedersen Bodil Ginnerup Pedersen
author_sort	Kim Morgenstjerne Oerskov
title	Postoperative MRI Findings Following Conventional and Extralevator Abdominoperineal Excision in Low Rectal Cancer
title_short	Postoperative MRI Findings Following Conventional and Extralevator Abdominoperineal Excision in Low Rectal Cancer
title_full	Postoperative MRI Findings Following Conventional and Extralevator Abdominoperineal Excision in Low Rectal Cancer
title_fullStr	Postoperative MRI Findings Following Conventional and Extralevator Abdominoperineal Excision in Low Rectal Cancer
title_full_unstemmed	Postoperative MRI Findings Following Conventional and Extralevator Abdominoperineal Excision in Low Rectal Cancer
title_sort	postoperative mri findings following conventional and extralevator abdominoperineal excision in low rectal cancer
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/808d5d0054d6439c9684ffa6aa93152a
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Postoperative MRI Findings Following Conventional and Extralevator Abdominoperineal Excision in Low Rectal Cancer

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