Rectal cancer invading adjacent organs (T4) and locally recurrent rectal cancer (LRRC) pose a special challenge for surgical resection. We investigate the diagnostic performance of MRI and the results that can be achieved with MRI-guided surgery. All consecutive patients who underwent MRI-based multivisceral resection for T4 rectal adenocarcinoma or LRRC between 2005 and 2019 were included. Pelvic MRI findings were reviewed according to a seven-compartment staging system and correlated with histopathology. Outcomes were investigated by comparing T4 tumors and LRRC with respect to cause-specific survival in uni- and multivariate analysis. We identified 48 patients with T4 tumors and 28 patients with LRRC. Overall, 529 compartments were assessed with an accuracy of 81.7%, a sensitivity of 88.6%, and a specificity of 79.2%. Understaging was as low as 3.0%, whereas overstaging was 15.3%. The median number of resected compartments was 3 (interquartile range 3–4) for T4 tumors and 4 (interquartile range 3–5) for LRRC (p= 0.017). In 93.8% of patients with T4 tumors, a histopathologically complete (R0(local)-) resection could be achieved compared to 57.1% in LRRC (p< 0.001). Five-year overall survival for patients with T4 tumors was 53.3% vs. 32.1% for LRRC (p= 0.085). R0-resection and M0-category emerged as independent prognostic factors, whereas the number of resected compartments was not associated with prognosis in multivariate analysis. MRI predicts compartment involvement with high accuracy and especially avoids understaging. Surgery based on MRI yields excellent loco-regional results for T4 tumors and good results for LRRC. The number of resected compartments is not independently associated with prognosis, but R0-resection remains the crucial surgical factor.
侵犯邻近器官的直肠癌（T4期）及局部复发性直肠癌（LRRC）对外科切除术提出了特殊挑战。本研究旨在探讨磁共振成像（MRI）的诊断效能及MRI引导手术的临床效果。研究纳入2005年至2019年间所有接受基于MRI的多脏器切除术的T4期直肠腺癌或LRRC连续病例。依据七分区分期系统评估盆腔MRI结果，并与组织病理学结果进行对照分析。通过单变量与多变量分析比较T4肿瘤与LRRC在病因特异性生存率方面的差异。 研究共纳入48例T4肿瘤患者和28例LRRC患者。总体评估529个解剖分区，诊断准确率为81.7%，敏感性88.6%，特异性79.2%。分期不足率仅为3.0%，而分期过度率为15.3%。T4肿瘤中位切除分区数为3个（四分位距3-4），LRRC为4个（四分位距3-5）（p=0.017）。93.8%的T4肿瘤患者实现组织病理学完全（R0局部）切除，而LRRC患者仅为57.1%（p<0.001）。T4肿瘤患者五年总生存率为53.3%，LRRC患者为32.1%（p=0.085）。多变量分析显示R0切除和M0分期是独立预后因素，而切除分区数量与预后无显著相关性。 MRI能高精度预测解剖分区受累情况，尤其能有效避免分期不足。基于MRI的手术方案使T4肿瘤获得优异的局部区域控制效果，LRRC也取得良好疗效。切除分区数量虽与预后无独立相关性，但R0切除仍是关键的外科决定因素。
肿瘤(癌症)患者之家