Identification of the fascia propria by magnetic resonance imaging and its relevance to preoperative assessment of rectal cancer

Ian P. Bissett, Charatha C. Fernando, David M. Hough, Brett R. Cowan, Kai Y. Chau, Alistair A. Young, Bryan R. Parry, Graham L. Hill

Research output: Contribution to journalArticlepeer-review

110 Scopus citations

Abstract

PURPOSE: If rectal cancer does not penetrate the fascia propria of the rectum and the rectum is removed with the fascial envelope intact (extrafascial excision), then local recurrence of the cancer will be minimal. Modern imaging techniques have identified a fascial plane surrounding the rectum and mesorectum, and it has been suggested that this is the fascia propria. The aim of this study was to identify whether this plane is the rectal fascia propria and whether tumor invasion through this fascia can be identified preoperatively. METHODS: Two separate experiments were performed: 1) pelvic magnetic resonance imaging was performed before and after dissection and marking of the plane of extrafascial dissection of the rectum of a cadaver; and 2) magnetic resonance imaging was performed in 43 rectal cancer patients preoperatively. Two radiologists independently reported the depth of tumor invasion in relation to the fascia propria. The tumors were resected by extrafascial excision, and a pathologist independently reported the relation of the tumor to the fascia propria. RESULTS: The marker inserted in the extrafascial plane showed that the plane visualized on pelvic magnetic resonance imaging was the fascia propria dissected in extrafascial excision of the rectum. The magnetic resonance imaging detected tumor penetration through the fascia propria with a sensitivity of 67 percent, a specificity of 100 percent, and an accuracy of 95 percent. CONCLUSION: The surgical fascia propria can be identified on preoperative magnetic resonance imaging in patients with rectal cancer. Tumor invasion through this fascia can be detected on magnetic resonance imaging. This method of assessment offers a new way to select those patients who require preoperative radiotherapy.

Original languageEnglish (US)
Pages (from-to)259-265
Number of pages7
JournalDiseases of the colon and rectum
Volume44
Issue number2
DOIs
StatePublished - Jan 1 2001

Keywords

  • Computed tomography
  • Fascia propria
  • Magnetic resonance imaging
  • Preoperative staging
  • Rectal cancer

ASJC Scopus subject areas

  • Gastroenterology

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