MRI-based score to predict surgical difficulty in patients with rectal cancer

Abstract : BACKGROUND: Rectal cancer surgery is technically challenging and depends on many factors. This study evaluated the ability of clinical and anatomical factors to predict surgical difficulty in total mesorectal excision. METHODS: Consecutive patients who underwent total mesorectal excision for locally advanced rectal cancer in a laparoscopic, robotic or open procedure after neoadjuvant treatment, between 2005 and 2014, were included in this retrospective study. Preoperative clinical and MRI data were studied to develop a surgical difficulty grade. RESULTS: In total, 164 patients with a median age of 61 (range 26-86) years were considered to be at low risk (143, 87·2 per cent) or high risk (21, 12·8 per cent) of surgical difficulty. In multivariable analysis, BMI at least 30 kg/m2 (P = 0·021), coloanal anastomosis (versus colorectal) (P = 0·034), intertuberous distance less than 10·1 cm (P = 0·041) and mesorectal fat area exceeding 20·7 cm2 (P = 0·051) were associated with greater surgical difficulty. A four-item score (ranging from 0 to 4), with each item (BMI, type of surgery, intertuberous distance and mesorectal fat area) scored 0 (absence) or 1 (presence), is proposed. Patients can be considered at high risk of a difficult or challenging operation if they have a score of 3 or more. CONCLUSION: This simple morphometric score may assist surgical decision-making and comparative study by defining operative difficulty before surgery.
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Contributeur : Anthony Herrada <>
Soumis le : vendredi 13 septembre 2019 - 10:41:50
Dernière modification le : lundi 18 novembre 2019 - 16:42:28




L. Escal, S. Nougaret, B. Guiu, M. Bertrand, H. de Forges, et al.. MRI-based score to predict surgical difficulty in patients with rectal cancer. British Journal of Surgery, Wiley, 2018, 105 (1), pp.140-146. ⟨10.1002/bjs.10642⟩. ⟨hal-02285849⟩



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