Validation of pelvic magnetic resonance imaging as the method of choice to determine the distance to the anal margin in rectal cancer

Miguel Ángel Lorenzo Liñán; Juan García Armengol; Gonzalo Pablo Martín Martín; Vicente Martínez Sanjuán; José Vicente Roig Vila

doi:10.1016/j.ciresp.2021.07.004

Validation of pelvic magnetic resonance imaging as the method of choice to determine the distance to the anal margin in rectal cancer

Cir Esp (Engl Ed). 2021 Sep 4:S0009-739X(21)00245-1. doi: 10.1016/j.ciresp.2021.07.004. Online ahead of print.

[Article in English, Spanish]

Authors

Miguel Ángel Lorenzo Liñán¹, Juan García Armengol², Gonzalo Pablo Martín Martín³, Vicente Martínez Sanjuán⁴, José Vicente Roig Vila²

Affiliations

¹ Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, , Almería, España; La filiación de Miguel Ángel Lorenzo Liñán, Juan García Armengol, Gonzalo Pablo Martin Martin y José Vicente Roig Vila en el momento de la realización de este artículo era: Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España. Electronic address: malorenzol@hotmail.com.
² Centro Europeo de Cirugía Colorrectal, Hospital Vithas Valencia 9 de Octubre, Valencia, España; La filiación de Miguel Ángel Lorenzo Liñán, Juan García Armengol, Gonzalo Pablo Martin Martin y José Vicente Roig Vila en el momento de la realización de este artículo era: Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España.
³ Cirugía, Centro Médico Teknon, Barcelona, España; La filiación de Miguel Ángel Lorenzo Liñán, Juan García Armengol, Gonzalo Pablo Martin Martin y José Vicente Roig Vila en el momento de la realización de este artículo era: Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España.
⁴ Servicio de Radiología y Resonancia Magnética, Consorcio Hospital General Universitario de Valencia, Valencia, España.

PMID: 34493375
DOI: 10.1016/j.ciresp.2021.07.004

Abstract

Introduction: Distance from anal verge of rectal tumors and their anatomical relationships contribute to determine the multidisciplinary therapeutic strategy based on the combination of radio-chemotherapy and radical surgery. Our aims are to investigate which is the most accurate method for the preoperative measuring of the distance from the anal verge in rectal tumors and if the pelvic MRI can substitute the classical instrumental methods.

Methods: Prospective study of diagnostic precision between flexible colonoscopy (FC), preoperative rigid rectosigmoidoscopy (pRR) and pelvic MRI in patients scheduled to radical surgery. Rigid intraoperative rectoscopy (iRR) was considered the reference test. The correlations between the different techniques and their determination coefficient as well as the intraclass correlation coefficient and the degree of agreement between the different tests were analyzed.

Results: 96 patients (65% males), mean age (SD): 68 (14.1) years were included. 72% received neoadjuvant treatment. The mean distance to the anal margin measured by FC=103.5mm, was significantly greater than others, which had similar values: pRR=81.1; MRI=77.4; iRR=82.9mm (P<.001). A significant intraclass correlation was observed and there was high agreement between all pre- and intraoperative measurements except for the performed by FC, which overestimated the results. MRI provided more individualized and accurate information.

Conclusions: There is variability between the measurement methods, being colonoscopy the least reliable. MRI offers objective, comparable, accurate and individualized values that can replace those obtained by pRR for tumors of any location in the rectum.

Keywords: Colonoscopia; Colonoscopy; Cáncer de recto; Distance to anal verge; Distancia al margen anal; Pelvic magnetic resonance imaging; Peritoneal anterior reflection; Rectal cancer; Rectosigmoidoscopia rígida; Reflexión peritoneal anterior; Resonancia magnética pélvica; Rigid rectosigmoidoscopy.