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Assessing surgical difficulty in locally advanced mid-low rectal cancer: the accuracy of two MRI-based predictive scores
- Source :
- COLORECTAL DISEASE, r-FISABIO. Repositorio Institucional de Producción Científica, instname, r-FISABIO: Repositorio Institucional de Producción Científica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
- Publication Year :
- 2019
- Publisher :
- Blackwell Publishing Inc., 2019.
-
Abstract
- Aim Predicting surgical difficulty is a critical factor in the management of locally advanced rectal cancer (LARC). This study evaluates the accuracy and external validity of a recently published morphometric score to predict surgical difficulty and additionally proposes a new score to identify preoperatively LARC patients with a high risk of having a difficult surgery. Methods This is a retrospective study based on the European MRI and Rectal Cancer Surgery (EuMaRCS) database, including patients with mid/low LARC who were treated with neoadjuvant chemoradiation therapy and laparoscopic total mesorectal excision (L-TME) with primary anastomosis. For all patients, pretreatment and restaging MRI were available. Surgical difficulty was graded as high and low based upon a composite outcome, including operative (e.g. duration of surgery) and postoperative variables (e.g. hospital stay). Score accuracy was assessed by estimating sensitivity, specificity and area under the receiver operating characteristic curve (AROC). Results In a total of 136 LARC patients, 17 (12.5%) were graded as high surgical difficulty. The previously published score (calculated on body mass index, intertuberous distance, mesorectal fat area, type of anastomosis) showed low predictive value (sensitivity 11.8%; specificity 92.4%; AROC 0.612). The new EuMaRCS score was developed using the following significant predictors of surgical difficulty: body mass index > 30, interspinous distance < 96.4 mm, ymrT stage >= T3b and male sex. It demonstrated high accuracy (AROC 0.802). Conclusion The EuMaRCS score was found to be more sensitive and specific than the previous score in predicting surgical difficulty in LARC patients who are candidates for L-TME. However, this score has yet to be externally validated.
- Subjects :
- Male
medicine.medical_specialty
Databases, Factual
Colorectal cancer
mri
rectal cancer
score
surgical difficulty
Anastomosis
Sensitivity and Specificity
External validity
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
medicine
Humans
Stage (cooking)
Rectal cancer
Retrospective Studies
Proctectomy
Receiver operating characteristic
Rectal Neoplasms
business.industry
Patient Selection
Rectum
Gastroenterology
Retrospective cohort study
Middle Aged
medicine.disease
Magnetic Resonance Imaging
Total mesorectal excision
Treatment Outcome
ROC Curve
Area Under Curve
030220 oncology & carcinogenesis
Female
Laparoscopy
030211 gastroenterology & hepatology
Radiology
business
Body mass index
MRI
Subjects
Details
- ISSN :
- 14628910
- Database :
- OpenAIRE
- Journal :
- COLORECTAL DISEASE, r-FISABIO. Repositorio Institucional de Producción Científica, instname, r-FISABIO: Repositorio Institucional de Producción Científica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
- Accession number :
- edsair.doi.dedup.....7038a4ca16d600d0c83e7ee075e15236