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The sigmoid take-off: An anatomical imaging definition of the rectum validated on specimen analysis.

Authors
  • D'Souza, Nigel1
  • Lord, Amy2
  • Shaw, Annabel2
  • Patel, Anisha3
  • Balyasnikova, Svetlana4
  • Tudyka, Vera5
  • Abulafi, Muti6
  • Moran, Brendan7
  • Rasheed, Shahnawaz4
  • Tekkis, Paris4
  • Terlizzo, Monica3
  • West, Nick8
  • Quirke, Philip8
  • Brown, Gina4
  • 1 Croydon University Hospital, UK; Royal Marsden Hospital, UK; Imperial College London, UK. Electronic address: nigel.d'[email protected]
  • 2 Croydon University Hospital, UK; Royal Marsden Hospital, UK; Imperial College London, UK.
  • 3 Royal Marsden Hospital, UK.
  • 4 Royal Marsden Hospital, UK; Imperial College London, UK.
  • 5 Kingston Hospital, UK.
  • 6 Croydon University Hospital, UK.
  • 7 Basingstoke Hospital, UK.
  • 8 Pathology & Data Analytics, Leeds Institute of Medical Research at St. James's, University of Leeds, UK.
Type
Published Article
Journal
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
Publication Date
Sep 01, 2020
Volume
46
Issue
9
Pages
1668–1672
Identifiers
DOI: 10.1016/j.ejso.2020.01.008
PMID: 32061459
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

A pre-operative imaging landmark to define the rectum would optimise clinical care of rectal cancer patients and research efforts to improve outcomes. The sigmoid take-off has been suggested as an imaging landmark for the rectosigmoid junction (RSJ). This study aimed to investigate whether this imaging definition of the rectum was validated by surgical specimen analysis. This prospective study recruited 20 patients undergoing surgery and undertook radiological and pathological analysis of their rectal specimens. The radiological landmark of the sigmoid take-off was identified on pre-operative magnetic resonance imaging (MRI), and the distance to the anterior peritoneal reflection was measured by two readers. After surgery, the distance from the beginning of the sigmoid mesocolon to the anterior peritoneal reflection to the beginning of the sigmoid mesocolon on the specimen was measured, and compared to the distance on MRI using Pearson's Correlation Coefficient and Bland-Altman plots. In 17 patients, the mean distance from the anterior peritoneal reflection to the RSJ on MRI was 20.3 mm and 23.1 mm for two readers, and on pathology was 20.6 mm. The mean differences between MRI and specimen measurements were -0.31 mm (-2.83 to 2.20 mm), and 2.51 mm (95% confidence interval -0.31 to 5.33 mm) for each reader, with correlation coefficients of 0.77 and 0.81. The sigmoid take-off has been validated on specimen analysis to be an imaging landmark that defines the termination of the rectum. This anatomical landmark can be used to classify tumours and guide treatment and research of sigmoid colon and rectal cancer. Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.

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