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Does the mesorectal fat area impact the histopathology metrics of the specimen in males undergoing TME for distal rectal cancer?

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Abstract

The aim of this study was to evaluate whether the mesorectal fat area (MFA) has an impact on the histopathology metrics of the specimen in male patients undergoing robotic total mesorectal excision (rTME) for cancer in the distal third of the rectum. Prospectively collected data of patients undergoing rTME for resectable rectal cancer by five surgeons during 3 years were extracted from the REgistry of Robotic SURgery for RECTal cancer (RESURRECT). MFA was measured at preoperative MRI. Distal rectal cancer was defined as within 6 cm from the anal verge. Specimen metrics included circumferential resection margin (CRM) measured by pathologists as involved if < 1 mm, distal resection margin (DRM) and TME quality. Of 890 patients who underwent rTME for rectal cancer, a subgroup analysis compared 116/581 (33.4%) with MFA > 20 cm2 to 231/581 (66.6%) with MFA ≤ 20 cm2. The mean CRM in patients with MFA > 20 cm2 was neither statistically nor clinically significantly different from patients with MFA ≤ 20 m2 (6.8 ± 5.6 mm vs. 6.0 ± 7.5 mm; p = 0.544). The quality of TME did not significantly differ: complete TME 84.3% vs. 80.3%; nearly complete TME 12.9% vs. 10.1%; incomplete TME 6.8% vs. 5.6%. The DRM was not significantly different: 1.9 ± 1.9 cm vs. 1.9 ± 2.5 cm; p = 0.847. In addition, the intraoperative complication rate was not significantly different: 4.3% (n = 5) vs. 2.2% (n = 5) (p = 0.314). This prospective multicenter study did not find any evidence to support that larger MFA would result in poorer histopathology metrics of the specimen when performing rTME in male patients with distal rectal cancer.

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Acknowledgements

RESURRECT Study Group: Seon-Hahn Kim, Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea. Guglielmo Niccolo Piozzi, Colorectal Division, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea. Rosa Jimenez-Rodriguez, Section of Colorectal Surgery, Hospital Universitario Virgen del Rocio, Sevilla, Spain. Li-Jen Kuo, Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan. Tomohiro Yamaguchi, Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan. Fabio Cianchi, Department of Surgery and Translational Medicine, Careggi Hospital, University of Florence, Florence, Italy. Oktar Asoglu, Bosphorus Clinical Research Academy, Istanbul, Turkey. Vusal Aliyev, Department of General Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey. Dejan Ignjatovic, Surgical Department, Akershus University Hospital, Lørenskog, Norway. Yosef Nasseri, Cedar Sinai Medical Center, Los Angeles, CA, USA. Moshe Barnajian, Cedar Sinai Medical Center, Los Angeles, CA, USA.

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Authors and Affiliations

  1. Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Taylor Pavilion, Suite D-365, 100 Woods Road, Valhalla, NY, 10595, USA

    Daniel Moritz Felsenreich, Mahir Gachabayov & Roberto Bergamaschi

  2. Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria

    Daniel Moritz Felsenreich

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  1. Daniel Moritz Felsenreich
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  2. Mahir Gachabayov
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RESURRECT Study Group

  • Seon-Hahn Kim
  • , Guglielmo Niccolo Piozzi
  • , Rosa Jimenez-Rodriguez
  • , Li-Jen Kuo
  • , Tomohiro Yamaguchi
  • , Fabio Cianchi
  • , Oktar Asoglu
  • , Vusal Aliyev
  • , Dejan Ignjatovic
  • , Yosef Nasseri
  •  & Moshe Barnajian

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Correspondence to Roberto Bergamaschi.

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All the authors disclose financial or non-financial interests that are directly or indirectly related to the work submitted for publication.

Research involving human participants and/or animals

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by Western Institutional Review Board (reference number: 1-1329396-1).

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Informed consent was obtained from all the individual participants included in the study.

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Felsenreich, D.M., Gachabayov, M., Bergamaschi, R. et al. Does the mesorectal fat area impact the histopathology metrics of the specimen in males undergoing TME for distal rectal cancer?. Updates Surg 75, 581–588 (2023). https://doi.org/10.1007/s13304-022-01429-9

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