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The impact of the mesorectal apparent diffusion coefficient value on surgical difficulty in laparoscopic anterior resection for rectal cancer

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Abstract

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.

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Funding

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Author information

Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan

    Hirofumi Suzumura, Masashi Tsuruta, Hirotoshi Hasegawa, Koji Okabayashi, Takashi Ishida, Yusuke Asada, Akitsugu Makino & Yuko Kitagawa

  2. Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyu-ku, 160-8582, Tokyo, Japan

    Shigeo Okuda

Authors
  1. Hirofumi Suzumura
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  2. Masashi Tsuruta
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  3. Hirotoshi Hasegawa
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  4. Koji Okabayashi
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  5. Takashi Ishida
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  6. Yusuke Asada
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  7. Akitsugu Makino
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  8. Shigeo Okuda
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  9. Yuko Kitagawa
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Contributions

HS and MT contributed equally to all aspects of this study. HS and MT participated in its design and coordination and helped draft the manuscript. KO, TI and YA participated in the design of the study and performed the statistical analysis. SO guided me in the measurement of imaging (i.e., apparent diffusion coefficient). HH and YK conceived of the study, participated in its design and coordination and helped to draft the manuscript.

Corresponding author

Correspondence to Masashi Tsuruta.

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Conflict of interest

The authors declare that they have no competing interest.

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Cite this article

Suzumura, H., Tsuruta, M., Hasegawa, H. et al. The impact of the mesorectal apparent diffusion coefficient value on surgical difficulty in laparoscopic anterior resection for rectal cancer. Surg Today 49, 239–244 (2019). https://doi.org/10.1007/s00595-018-1727-7

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  • DOI: https://doi.org/10.1007/s00595-018-1727-7

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