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The impact of the mesorectal apparent diffusion coefficient value on surgical difficulty in laparoscopic anterior
Hirofumi Suzumura1, Masashi Tsuruta2, Hirotoshi Hasegawa1
1Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan.
Purpose:
We aimed to clarify the impact of the apparent diffusion coefficient (ADC) value of the mesorectum from preoperative magnetic resonance imaging (MRI) on surgical difficulty in laparoscopic anterior resection (Lap-AR) for rectal cancer.
Methods:
In total, 67 patients who had undergone curative Lap-AR for rectal cancer in our hospital from January 2008 to March 2015 and had preoperative MRI findings available were included. We randomly calculated the average ADC in three regions of the mesorectum at the level of the upper edge of the superior border of the femur. Univariate and multivariate analyses were performed to evaluate the correlation between the patients' clinicopathological characteristics, including the ADC value and short-term surgical outcomes.
Results:
The univariate analysis revealed that a lower ADC value was associated with a significantly increased operative blood loss (p = 0.008) and prolonged operative time (p < 0.001). The multivariate analysis adjusted for the body mass index, anal verge, tumor location, covering stoma, clinical T factor and conversion revealed that the ADC value was an independent risk factor for a prolonged operative time (R2 = 0.6003, p < 0.001). Furthermore, the multivariate analysis adjusted for the body mass index, anal verge, covering stoma, clinical T factor and conversion revealed that the ADC value was an independent risk factor for an increased blood loss (R2 = 0.4345, p = 0.008).
Conclusion:
A lower ADC value of the mesorectum might be a predictor of surgical difficulty in Lap-AR for rectal cancer.
Insights
Lower apparent diffusion coefficient (ADC) values in preoperative MRI scans predict increased surgical difficulty during laparoscopic anterior resection (Lap-AR) for rectal cancer, indicating higher operative time and blood loss.
Area of Science:
- Oncology
- Radiology
- Surgical Oncology
Background:
- Laparoscopic anterior resection (Lap-AR) is a standard treatment for rectal cancer.
- Predicting surgical difficulty in Lap-AR is crucial for patient outcomes and surgical planning.
Purpose of the Study:
- To investigate the association between preoperative magnetic resonance imaging (MRI)-derived apparent diffusion coefficient (ADC) values of the mesorectum and surgical difficulty in Lap-AR for rectal cancer.
Main Methods:
- Sixty-seven patients undergoing curative Lap-AR for rectal cancer with available preoperative MRI were analyzed.
- Average ADC values of the mesorectum were calculated.
- Univariate and multivariate analyses correlated ADC values with clinicopathological characteristics and short-term surgical outcomes.
Main Results:
- Lower mesorectal ADC values were significantly associated with increased operative blood loss (p=0.008) and prolonged operative time (p<0.001).
- Multivariate analysis confirmed ADC value as an independent risk factor for prolonged operative time (R²=0.6003, p<0.001) and increased blood loss (R²=0.4345, p=0.008).
Conclusions:
- Preoperative mesorectal ADC values may serve as a predictive marker for surgical difficulty in Lap-AR for rectal cancer.
- Lower ADC values indicate a potentially more challenging surgical procedure.
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