Pre-operative MRI does not accuratelypredict the requirement for AP Resection (APR) in low rectal cancer: LTP64


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Abstract

Aims:MRI is the gold standard in staging rectal cancer,predicting circumferential resection margin (CRM) involvement and the need forpreoperative radiotherapy (DXT). We assessed whetherpreoperative MRI couldpredict requirement for APR.Method:We identified patients with rectal tumours below the peritoneal reflection. Preoperative MRI scans were examined by a radiologist blinded to eventual surgery. The anal sphincters were rated clear, equivocal or involved. MRIprediction and final surgicalprocedure were compared.Results:Of 36 patients (24M, 12F, median age 69 (41-87)), 24 (66%) underwent LAR, 10 (28%) APR, and 2 (6%) a Hartmann'sprocedure (HP). 20 (56%) received DXT. MRI rated 28 cancers clear of the sphincters; 14 received DXT. Twenty-two patients underwent LAR, 2 HP and 4 APR. One had a positive CRM. Six were rated equivocal; four received DXT. Two underwent LAR and four APR. Two had a positive CRM. Two involved the sphincters radiologically; both had DXT then APR. One CRM was positive. Overall CRM was positive in 11% of these low rectal cancers. No patients undergoing LAR/HP had distal margin involvement.Conclusion:Although important inpredicting CRM involvement, MRI did not correctlypredict surgicalprocedure in 10 of 36 patients (28%) with low rectal cancer.

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