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Updated: Jan 29, 2026

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
MRI-Based Morphological Features as Predictors of Clinical Outcomes in Locally Advanced Rectal Cancer Treated with
Marco Lucarelli1, Consuelo Rosa2, Giulia de Pasquale2
1Division of Radiation Oncology, European Institute of Oncology IRCSS, 20141 Milan, Italy.
Abstract:
Objectives: This study evaluates MRI-based morphological features as predictors of long-term clinical outcomes in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (CRT). Methods: A retrospective analysis was performed on 134 patients treated between 2014 and 2024. Patients underwent dose-intensified radiotherapy (55 Gy) with concurrent capecitabine followed by surgery. Radiological features analyzed on pre- and post-CRT MRI included Tumor Extension Beyond Muscularis Propria (TEMP), Circumferential Resection Margin (CRM), Extramural Venous Invasion (EMVI), and Lateral Lymph Nodes (LLN). Results: Five-year Overall Survival (OS), Disease-Free Survival (DFS), and Local Control (LC) rates were 85%, 83%, and 88%, respectively. Patients with TEMP > 5 mm had significantly worse LC (p = 0.02) and DFS (p = 0.04). A positive CRM (<1 mm) significantly correlated with reduced DFS (p = 0.04). The presence of EMVI was associated with significantly lower LC (p = 0.01). Additionally, persistent pathological LLN after treatment significantly impacted LC (p = 0.04). Conclusions: MRI morphological features such as TEMP > 5 mm, CRM < 1 mm, EMVI, and pathological LLN are significant predictors of worse oncological outcomes. Identifying these imaging biomarkers allows for better risk stratification and personalized treatment strategies in LARC.
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