Role of Multimodal Preoperative Evaluation System in Prediction to Operative Strategies for Lower and Middle Rectal Cancer: A Randomized Controlled Trial_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xiaodong ¹ , LV Donghao ² , SONG Huan ² , YAN Libo ² , WU Junhua ³ , SHI Yingyu ⁴ , LI Zhenhui ⁵ , LI Li ¹

1.Department of Anal-Colorectal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;;
2.West China Medical School, Sichuan University, Chengdu 610041, China;;
3.Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China;;
4.Department of Sonography, West China Hospital, Sichuan University, Chengdu 610041, China;;
5.Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Lower and middle rectal cancer; Surgical operation; Multi-slice spiral computer tomography; Transrectal ultrasound; Serum amyloid A protein; Multimodal preoperative evaluation

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Objective To determine the role of multimodal preoperative evaluation (MPE) system of transrectal ultrasound (TRUS), 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) in assessment of preoperative staging and selection of operative procedures of the lower and middle rectal cancer in multi-disciplinary team. Methods Prospectively enrolled 150 patients, who were diagnosed definitely as lower and middle rectal cancer (distance of tumor to the dentate line ≤10 cm) at West China Hospital of Sichuan University from November 2008 to March 2009, randomly assigned into two groups. In one group named MPE group, MPE consisting of TRUS, MSCT and SAA were made for the preoperative evaluation. In another group named MSCT+SAA group, both MSCT and SAA were made preoperatively. Then, the preoperative staging and predicted operative procedures were compared with postoperative pathologic staging and practical operative procedures, respectively. Furthermore, the pooled data were analyzed for the correlative relationship between the choice of surgery strategy and clinicopathological factors. Results According to the criteria, 146 patients with lower and middle rectal cancer were randomly assigned into MPE group (n=74) and MSCT+SAA group (n=72). The baselines characteristics of two groups were statistically identical. For MPE group the accuracy of preoperative staging T, N, M and TNM were 94.6% (70/74), 85.1% (63/74), 100% （74/74） and 82.4% (61/74), respectively; For MSCT+SAA group the corresponding rates were 77.8% (56/72), 84.7% (61/72), 100% （72/72） and 81.9% (59/72), respectively. The analysis showed a statistically difference in the accuracy of preoperative T staging between two groups (P=0.003) while there was no statistically significant difference of the accuracies of preoperative N, M and TNM staging between two groups (P gt;0.05). There wasn’t a statistically significant increasing of the accuracy of prediction to operative procedures in MPE group compared with MSCT+SAA group 〔95.9% (71/74) vs.88.9% (64/72), P=0.106〕. When analyzing the relationship between multiple clinicopathologic factors and the operative procedures of lower and middle rectal cancer, there were statistical correlations between the pathological T staging (r=0.216， P=0.009), N staging (r=0.264， P=0.001), TNM staging (r=0.281， P=0.001), serum level of SAA before operation (r=0.252， P=0.002) or the distance of tumor to the dentate line (r=－0.261， P=0.001) and the operative procedures. Conclusion MPE system could display the accurate preoperative staging for lower and middle rectal cancer, on which the prediction of operative procedures can rest convincingly.

Citation： WANG Xiaodong,LV Donghao,SONG Huan,YAN Libo,WU Junhua,SHI Yingyu,LI Zhenhui,LI Li. Role of Multimodal Preoperative Evaluation System in Prediction to Operative Strategies for Lower and Middle Rectal Cancer: A Randomized Controlled Trial. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(6): 487-492. doi: Copy

1.	] 汪晓东, 吕东昊, 崔贝贝, 等. 术前经直肠超声评估直肠癌手术方案的随机对照试验 [Ｊ]. 中国循证医学杂志, 2008; 8(12): 1043-1046.
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3.	Muthusamy VR, Chang KJ. Optimal methods for staging re-ctal cancer [Ｊ]. Clin Cancer Res, 2007; 13(22 Pt 2): 6877s-6884s.
4.	吴俊华, 汪晓东, 高强, 等. 64排多层螺旋CT和血清淀粉样蛋白A联合评估下段直肠癌对手术方案选择的影响 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(2): 156-161.
5.	汪晓东, 尹源, 陆玫竹, 等. 经直肠超声联合血清淀粉样蛋白A术前评估中低位直肠癌与手术决策的随机对照试验 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(5): 407-412.
6.	Thoeni RF. Colorectal cancer: cross-sectional imaging for st-aging of primary tumor and detection of local recurrence [Ｊ]. AJR Am J Roentgenol, 1991; 156(5): 909-915.
7.	Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound [Ｊ]. Dis Colon Rectum, 1985; 28(1): 42-46.
8.	Greene FL, Page DL, Fleming ID, et al Eds. AJCC cancer staging manual [M]. 6th ed. New York(NY): Springer-Verlag, 2002: 113-124.
9.	汪晓东, 吕东昊, 曾天芳, 等. 多学科协作诊治模式下结直肠癌术前辅助检查系统的临床应用初步探索 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(1): 70-74.
10.	Hosein PJ, Rocha-Lima CM. Role of combined-modality therapy in the management of locally advanced rectal cancer [Ｊ]. Clin Colorectal Cancer, 2008; 7(6): 369-375.
11.	Stocchi L, Nelson H, Sargent DJ, et al. Impact of surgical and pathologic variables in rectal cancer: a United States community and cooperative group report [Ｊ]. J Clin Oncol, 2001; 19(18): 3895-3902.
12.	李立. 结直肠癌外科应用技术的规范与创新(一) [Ｊ]. 中国普外基础与临床杂志, 2006; 13(1): 106-109.
13.	蔡三军. 直肠癌的外科治疗进展 [Ｊ]. 中国癌症杂志, 2004; 14(5): 410-414.
14.	汪晓东, 何帆, 邓窈窕, 等. 直肠癌术前经直肠超声评估保肛或非保肛手术方案的临床前瞻性研究 [Ｊ]. 临床外科杂志, 2008; 16(11): 755-757.
15.	汪晓东, 宋欢, 吕东昊, 等. 术前联合评估直肠上段癌与手术方案选择的随机对照试验 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(4): 322-326.
16.	Glojnaric＇ I, Casl MT, Simic＇ I D, et al. Serum amyloid A protein (SAA) in colorectal carcinoma [Ｊ]. Clin Chem Lab Med, 2001; 39(2): 129-133.
17.	Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging [Ｊ]. Radiol Clin North Am, 2007; 45(1): 85-118.
18.	Dinter DJ, Hofheinz RD, Hartel M, et al. Preoperative staging of rectal tumors: comparison of endorectal ultrasound, hydro-CT, and high-resolution endorectal MRI [Ｊ]. Onkologie, 2008; 31(5): 230-235.
19.	Panzironi G, De Vargas Macciucca M, Manganaro L, et al. Preoperative locoregional staging of rectal carcinoma: comparison of MR, TRUS and Multislice CT. Personal experience [Ｊ]. Radiol Med, 2004; 107(4): 344-355.
20.	Schaffzin DM, Wong WD. Endorectal ultrasound in the preoperative evaluation of rectal cancer [Ｊ]. Clin Colorectal Cancer, 2004; 4(2): 124-132.
21.	李立，汪晓东, 舒晔, 等. 四川大学华西医院·结直肠癌手术治疗指南(一) [Ｊ]. 中国普外基础与临床杂志, 2008; 15(10): 778.

1. ] 汪晓东, 吕东昊, 崔贝贝, 等. 术前经直肠超声评估直肠癌手术方案的随机对照试验 [Ｊ]. 中国循证医学杂志, 2008; 8(12): 1043-1046.
2. Bipat S, Glas AS, Slors FJ, et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging-a meta-analysis [Ｊ]. Radiology, 2004; 232(3): 773-83.
3. Muthusamy VR, Chang KJ. Optimal methods for staging re-ctal cancer [Ｊ]. Clin Cancer Res, 2007; 13(22 Pt 2): 6877s-6884s.
4. 吴俊华, 汪晓东, 高强, 等. 64排多层螺旋CT和血清淀粉样蛋白A联合评估下段直肠癌对手术方案选择的影响 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(2): 156-161.
5. 汪晓东, 尹源, 陆玫竹, 等. 经直肠超声联合血清淀粉样蛋白A术前评估中低位直肠癌与手术决策的随机对照试验 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(5): 407-412.
6. Thoeni RF. Colorectal cancer: cross-sectional imaging for st-aging of primary tumor and detection of local recurrence [Ｊ]. AJR Am J Roentgenol, 1991; 156(5): 909-915.
7. Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound [Ｊ]. Dis Colon Rectum, 1985; 28(1): 42-46.
8. Greene FL, Page DL, Fleming ID, et al Eds. AJCC cancer staging manual [M]. 6th ed. New York(NY): Springer-Verlag, 2002: 113-124.
9. 汪晓东, 吕东昊, 曾天芳, 等. 多学科协作诊治模式下结直肠癌术前辅助检查系统的临床应用初步探索 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(1): 70-74.
10. Hosein PJ, Rocha-Lima CM. Role of combined-modality therapy in the management of locally advanced rectal cancer [Ｊ]. Clin Colorectal Cancer, 2008; 7(6): 369-375.
11. Stocchi L, Nelson H, Sargent DJ, et al. Impact of surgical and pathologic variables in rectal cancer: a United States community and cooperative group report [Ｊ]. J Clin Oncol, 2001; 19(18): 3895-3902.
12. 李立. 结直肠癌外科应用技术的规范与创新(一) [Ｊ]. 中国普外基础与临床杂志, 2006; 13(1): 106-109.
13. 蔡三军. 直肠癌的外科治疗进展 [Ｊ]. 中国癌症杂志, 2004; 14(5): 410-414.
14. 汪晓东, 何帆, 邓窈窕, 等. 直肠癌术前经直肠超声评估保肛或非保肛手术方案的临床前瞻性研究 [Ｊ]. 临床外科杂志, 2008; 16(11): 755-757.
15. 汪晓东, 宋欢, 吕东昊, 等. 术前联合评估直肠上段癌与手术方案选择的随机对照试验 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(4): 322-326.
16. Glojnaric＇ I, Casl MT, Simic＇ I D, et al. Serum amyloid A protein (SAA) in colorectal carcinoma [Ｊ]. Clin Chem Lab Med, 2001; 39(2): 129-133.
17. Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging [Ｊ]. Radiol Clin North Am, 2007; 45(1): 85-118.
18. Dinter DJ, Hofheinz RD, Hartel M, et al. Preoperative staging of rectal tumors: comparison of endorectal ultrasound, hydro-CT, and high-resolution endorectal MRI [Ｊ]. Onkologie, 2008; 31(5): 230-235.
19. Panzironi G, De Vargas Macciucca M, Manganaro L, et al. Preoperative locoregional staging of rectal carcinoma: comparison of MR, TRUS and Multislice CT. Personal experience [Ｊ]. Radiol Med, 2004; 107(4): 344-355.
20. Schaffzin DM, Wong WD. Endorectal ultrasound in the preoperative evaluation of rectal cancer [Ｊ]. Clin Colorectal Cancer, 2004; 4(2): 124-132.
21. 李立，汪晓东, 舒晔, 等. 四川大学华西医院·结直肠癌手术治疗指南(一) [Ｊ]. 中国普外基础与临床杂志, 2008; 15(10): 778.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Role of Multimodal Preoperative Evaluation System in Prediction to Operative Strategies for Lower and Middle Rectal Cancer: A Randomized Controlled Trial

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