Extent and completeness of mesorectal excision evaluated by postoperative magnetic resonance imaging

Background: The major advance in rectal cancer management over the past 20years has been the standardization of mesorectal excision. The aim of this study was to determine the prevalence and localization of inadvertent residual mesorectum detected on magnetic resonance imaging (MRI) after rectal cancer surgery. Methods: Postoperative T2-weighted MRI of the pelvis was performed on patients following mesorectal excision. A multidisciplinary team radiologist evaluated the images with regard to residual mesorectum and distal margin. Only mesorectum above the level of the anastomosis perpendicular to the bowel was regarded as inadvertent residual mesorectum after partial mesorectal excision. Histopathological records, standardized photographs and clinical records were assessed. The pathology and MRI findings were evaluated independently in a blinded fashion. Results: MRI-detected residual mesorectum was identified in 54 (397 per cent) of 136 patients. There was agreement with the pathology findings in 88 patients (647 per cent). Residual mesorectum was more frequent in patients treated with partial mesorectal excision (63 per cent) than those who had total mesorectal excision (36 per cent) or abdominoperineal resection (13 per cent) (P<0001). Pathology and MRI findings both showed that the distal resection margin after partial mesorectal excision was less than 5cm in more than three-quarters of patients, and less than 3cm in more than one-third. Conclusion: Inadvertent residual mesorectum was commonly found on postoperative MRI, especially after partial mesorectal excision.