Assessing surgical difficulty in locally advanced mid–low rectal cancer: the accuracy of two MRI-based predictive scores
Corresponding Author
N. de'Angelis
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
Correspondence to: Dr N. de'Angelis, Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
E-mail: [email protected]
Search for more papers by this authorF. Pigneur
Department of Radiology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
Search for more papers by this authorA. Martínez-Pérez
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
Search for more papers by this authorG. C. Vitali
Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
Search for more papers by this authorF. Landi
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
Search for more papers by this authorS. A. Gómez-Abril
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
Search for more papers by this authorM. Assalino
Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
Search for more papers by this authorE. Espin
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
Search for more papers by this authorF. Ris
Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
Search for more papers by this authorA. Luciani
Department of Radiology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
Search for more papers by this authorF. Brunetti
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
Search for more papers by this authorthe EuMaRCS Study Group
EuMaRCS Study Group members are presented in the Acknowledgements.Search for more papers by this authorCorresponding Author
N. de'Angelis
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
Correspondence to: Dr N. de'Angelis, Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
E-mail: [email protected]
Search for more papers by this authorF. Pigneur
Department of Radiology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
Search for more papers by this authorA. Martínez-Pérez
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
Search for more papers by this authorG. C. Vitali
Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
Search for more papers by this authorF. Landi
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
Search for more papers by this authorS. A. Gómez-Abril
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
Search for more papers by this authorM. Assalino
Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
Search for more papers by this authorE. Espin
Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
Search for more papers by this authorF. Ris
Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
Search for more papers by this authorA. Luciani
Department of Radiology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
Search for more papers by this authorF. Brunetti
Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, Créteil, France
Search for more papers by this authorthe EuMaRCS Study Group
EuMaRCS Study Group members are presented in the Acknowledgements.Search for more papers by this authorAbstract
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.
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