Postoperative CT Evaluation of Total Mesorectal Excision with Anal Sphincter Preservation in Patients with Low Rectal Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Bing , LU Chunyan , LIU Rongbo , HUANG Zixing , SUN Jiayu , LI Zhenlin , SONG Bin.

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

Keywords：

Rectal neoplasm; Total mesorectal excision; Tomography/Computed

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ObjectiveTo investigate the value of postoperative CT examination for evaluation of local complications in patients with low rectal carcinoma after total mesorectal excision with anal sphincter preservation. MethodsThe patients with low rectal carcinoma who received total mesorectal excision (TME) with anal sphincter preservation were examined using contrastenhanced CT in one year period from May 2009 to May 2010. Particular attention was paid to the presence of anastomotic leakage, local recurrence and status of lymph nodes. ResultsTotal of 82 patients (52 men, 30 women； mean age 57.8 years old； range 25.74 years old) were included in the study. Over a mean 10-month follow-up， 8 cases （9.8%） had clinically or surgically confirmed anastomotic leak, 6 cases （7.3%） had local recurrence around the anastomotic site， and 4 cases （4.9%） showed pelvic and distant metastatic lymphadenopathy. ConclusionPostoperative CT examination, including baseline and follow-up CT studies, is very useful for diagnosing anastomotic leakage, local tumor recurrence and lymphadenopathy.

Citation： WU Bing,LU Chunyan,LIU Rongbo,HUANG Zixing,SUN Jiayu,LI Zhenlin,SONG Bin.. Postoperative CT Evaluation of Total Mesorectal Excision with Anal Sphincter Preservation in Patients with Low Rectal Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(11): 1227-1230. doi: Copy

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2.	Yu YY, Wang C, Xu D, et al. Mesorectal and lateral node metastasis and micrometastasis in lower rectal cancer [J]. Hepatogastroenterology, 2011, 58(107108): 745748.
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4.	Herzog T, Belyaev O, Chromik AM, et al. TME quality in rectal cancer surgery [J]. Eur J Med Res, 2010, 15(7): 292296.
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6.	Rahbari NN, Ulrich AB, Bruckner T, et al. Surgery for locally recurrent rectal cancer in the era of total mesorectal excision: is there still a chance for cure? [J]. Ann Surg, 2011, 253(3): 522533.
7.	于永扬，杨烈，周总光，等．腹腔镜全直肠系膜切除保肛术后生活质量评估 [J]．中国普外基础与临床杂志， 2007， 14（5）： 524529．.
8.	汪晓东，曹霖，曾天芳，等．多学科协作诊治模式下新辅助化疗对直肠癌术后近期并发症影响的临床对照研究 [J]．中国普外基础与临床杂志， 2008， 15（4）： 289294, 302．.
9.	庄建良，苏子剑，潘群雄，等．直肠癌双吻合器保肛手术后吻合口漏的探讨 [J]．中国普外基础与临床杂志， 2010， 17（3）： 279280．.
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12.	Platell C, Barwood N, Dorfmann G, et al. The incidence of anastomotic leaks in patients undergoing colorectal surgery [J]. Colorectal Dis, 2007, 9(1): 7179.
13.	Tan PL, Chan CL, Moore NR. Radiological appearances in the pelvis following rectal cancer surgery [J]. Clin Radiol, 2005, 60(8): 846855.
14.	顾晋，杜长征．直肠癌全系膜切除术后吻合口漏的防治 [J]．中华胃肠外科杂志， 2007， 10（5）： 496499．.
15.	张宏，陈春生，乔雷，等．低位直肠癌双吻合器保肛手术后吻合口漏的预防策略 [J]．中国普外基础与临床杂志， 2007， 14（1）： 8990．.
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17.	陈继贵，路直美，陈华荣，等．直肠癌前切除术后吻合口漏预防方法的探讨 [J]．中国普外基础与临床杂志， 2007， 14（3）： 329330．.
18.	纪盛章，张培达．直肠癌术前检查及分期 [J]．中华放射学杂志， 1992， 26（2）： 9194．.
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20.	Klos CL, Bordeianou LG, Sylla P, et al. The prognostic value of lymph node ratio after neoadjuvant chemoradiation and rectal cancer surgery [J]. Dis Colon Rectum, 2011, 54(2): 171175.
21.	McCarthy SM, Barnes D, Deveney K, et al. Detection of recurrent rectosigmoid carcinoma: prospective evaluation of CT and clinical factors [J]. AJR Am J Roentgenol, 1985, 144(3): 577579.
22.	刘于宝，梁长虹，张忠林，等． 64层螺旋CT灌注成像评价直肠癌术后复发或瘢痕组织 [J]．放射学实践， 2006， 21（5）： 503506．.
23.	Kobayashi H, Mochizuki H, Kato T, et al. Lymph node ratio is a powerful prognostic index in patients with stage Ⅲ distal rectal cancer: a Japanese multicenter study [J]. Int J Colorectal Dis, 2011, 26(7): 891896.
24.	李德福，张敏．直肠癌淋巴结转移与临床病理特征分析 [J]．中国普外基础与临床杂志， 2008， 15（9）： 652655．.
25.	Kawahara H, Watanabe K, Ushigome T, et al. Laparoscopyassisted lateral pelvic lymph node dissection for advanced rectal cancer [J]. Hepatogastroenterology, 2010, 57(102103): 11361138.
26.	Zafar HM, Mahmoud NN, Mitra N, et al. Resected colorectal cancer among medicare beneficiaries:adoption of FDG PET [J]. Radiology, 2010, 254(2): 501508.

1. Heald RJ. Total mesorectal excision is optimal surgery for rectal cancer: a scandinavian consensus [J]. Br J Surg, 1995, 82(10): 12971299.
2. Yu YY, Wang C, Xu D, et al. Mesorectal and lateral node metastasis and micrometastasis in lower rectal cancer [J]. Hepatogastroenterology, 2011, 58(107108): 745748.
3. Moran DC, Kavanagh DO, Nugent E, et al. Laparoscopic resection for low rectal cancer: evaluation of oncological efficacy [J]. Int J Colorectal Dis, 2011, 26(9): 11431149.
4. Herzog T, Belyaev O, Chromik AM, et al. TME quality in rectal cancer surgery [J]. Eur J Med Res, 2010, 15(7): 292296.
5. Park JS, Choi GS, Lim KH, et al. Laparoscopic extended lateral pelvic node dissection following total mesorectal excision for advanced rectal cancer: initial clinical experience [J]. Surg Endosc, 2011, 25(10): 33223329.
6. Rahbari NN, Ulrich AB, Bruckner T, et al. Surgery for locally recurrent rectal cancer in the era of total mesorectal excision: is there still a chance for cure? [J]. Ann Surg, 2011, 253(3): 522533.
7. 于永扬，杨烈，周总光，等．腹腔镜全直肠系膜切除保肛术后生活质量评估 [J]．中国普外基础与临床杂志， 2007， 14（5）： 524529．.
8. 汪晓东，曹霖，曾天芳，等．多学科协作诊治模式下新辅助化疗对直肠癌术后近期并发症影响的临床对照研究 [J]．中国普外基础与临床杂志， 2008， 15（4）： 289294, 302．.
9. 庄建良，苏子剑，潘群雄，等．直肠癌双吻合器保肛手术后吻合口漏的探讨 [J]．中国普外基础与临床杂志， 2010， 17（3）： 279280．.
10. Inoue Y, Hiro J, Toiyama Y, et al. PushBack technique facilitates UltraLow anterior resection without nerve injury in total mesorectal excision for rectal cancer [J]. Dig Surg, 2011, 28(4): 239244.
11. 范恩学，房学东，孙海侠，等．直肠癌TME与非TME手术临床分析 [J]．中国现代普通外科进展， 2009， 12（10）： 875878．.
12. Platell C, Barwood N, Dorfmann G, et al. The incidence of anastomotic leaks in patients undergoing colorectal surgery [J]. Colorectal Dis, 2007, 9(1): 7179.
13. Tan PL, Chan CL, Moore NR. Radiological appearances in the pelvis following rectal cancer surgery [J]. Clin Radiol, 2005, 60(8): 846855.
14. 顾晋，杜长征．直肠癌全系膜切除术后吻合口漏的防治 [J]．中华胃肠外科杂志， 2007， 10（5）： 496499．.
15. 张宏，陈春生，乔雷，等．低位直肠癌双吻合器保肛手术后吻合口漏的预防策略 [J]．中国普外基础与临床杂志， 2007， 14（1）： 8990．.
16. 高云峰，董明．直肠癌前切除术后吻合口漏的危险因素 [J]．世界华人消化杂志， 2010， 18（8）： 803807．.
17. 陈继贵，路直美，陈华荣，等．直肠癌前切除术后吻合口漏预防方法的探讨 [J]．中国普外基础与临床杂志， 2007， 14（3）： 329330．.
18. 纪盛章，张培达．直肠癌术前检查及分期 [J]．中华放射学杂志， 1992， 26（2）： 9194．.
19. EnríquezNavascués JM, Borda N, Lizerazu A, et al. Patterns of local recurrence in rectal cancer after a multidisciplinary approach [J]. World J Gastroenterol, 2011, 17(13): 16741684.
20. Klos CL, Bordeianou LG, Sylla P, et al. The prognostic value of lymph node ratio after neoadjuvant chemoradiation and rectal cancer surgery [J]. Dis Colon Rectum, 2011, 54(2): 171175.
21. McCarthy SM, Barnes D, Deveney K, et al. Detection of recurrent rectosigmoid carcinoma: prospective evaluation of CT and clinical factors [J]. AJR Am J Roentgenol, 1985, 144(3): 577579.
22. 刘于宝，梁长虹，张忠林，等． 64层螺旋CT灌注成像评价直肠癌术后复发或瘢痕组织 [J]．放射学实践， 2006， 21（5）： 503506．.
23. Kobayashi H, Mochizuki H, Kato T, et al. Lymph node ratio is a powerful prognostic index in patients with stage Ⅲ distal rectal cancer: a Japanese multicenter study [J]. Int J Colorectal Dis, 2011, 26(7): 891896.
24. 李德福，张敏．直肠癌淋巴结转移与临床病理特征分析 [J]．中国普外基础与临床杂志， 2008， 15（9）： 652655．.
25. Kawahara H, Watanabe K, Ushigome T, et al. Laparoscopyassisted lateral pelvic lymph node dissection for advanced rectal cancer [J]. Hepatogastroenterology, 2010, 57(102103): 11361138.
26. Zafar HM, Mahmoud NN, Mitra N, et al. Resected colorectal cancer among medicare beneficiaries:adoption of FDG PET [J]. Radiology, 2010, 254(2): 501508.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Postoperative CT Evaluation of Total Mesorectal Excision with Anal Sphincter Preservation in Patients with Low Rectal Carcinoma

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