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Gastrointestinal Neoplasms

Intestinal Neoplasms

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Rectal Diseases

Neoplasms, Cystic, Mucinous, and Serous

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Adenocarcinoma, Mucinous

Rectal Neoplasms

Colonic Diseases

Patients with mrEMVI positive rectal cancer

Patients with mrEMVI negative rectal cancer

Gina Brown

Extramural venous invasion (EMVI) is the spread of microscopic tumour cells into the veins around the tumour. Rectal cancer treatment has improved greatly over recent years. However, it is important for us to learn as much about the tumours as possible in order to develop newer therapies. Current treatments may benefit from new genetic information relating to the cancer. We hope to identify genetic differences in certain types of rectal cancer which will allow future treatments.

Neoadjuvant chemoradiotherapy (CRT) is widely accepted as beneficial to selected patients in terms of decreased risk of local recurrence and overall survival. Current management of rectal cancer involves risk stratification through pre-operative staging leading to formulation of treatment strategy. Very little is known about the long-term outcomes and response to CRT on MRI detected extramural venous invasion (mrEMVI). Although mrEMVI is accepted as a marker of poor prognosis, whether it has a predictive value and should be specifically treated is not known.

Molecular and genetic profiling provides us with an opportunity to understand the underlying mechanisms which govern clinical behaviour in rectal cancer. Using high-throughput technology such as tissue microarray analysis allows large-scale analysis of specimens in a relatively short amount of time. It offers the ability to compare the molecular profiles of different subtypes of rectal cancer such as mrEMVI-positive and -negative tumours and whether any changes are observed following CRT. This can then be correlated with clinical behaviour over the medium and long-term with regards to local recurrence, distant metastases and overall survival.

This study will identify important differences between key rectal cancer tumour subtypes. Identification of reliable pathological markers of EMVI pathways (from both the primary tumour sample, but more importantly from the pre-operative biopsies) has real potential for taking us a step closer to more personalised management of rectal cancer by establishing prognostic biomarkers reflective of disease type, but also through the underlying biology that may be highlighted (with its promise of therapeutic translation).

Histopathology samples taken after rectal tumour removal surgery will be analysed using micrarray techniques. The pathological tissue microarrays (TMAs) will be generated using the Alphelys Tissue Arrayer Minicore®3 system. Markers that will be evaluated will be initially directed at epithelial to mesenchymal (EMT) transition pathways, as our preliminary studies suggest that this phylogenetically conserved molecular program has important roles in tumour dissemination and resistance to conventional chemotherapy.

Molecular, Pathologic and MRI Investigation of the Prognostic and Redictive Importance of Extramural Venous Invasion in Rectal Cancer (MARVEL) Trial

Molecular, Pathologic and MRI Investigation of the Prognostic and Redictive Importance of Extramural Venous Invasion in Rectal Cancer

mrEMVI Regression Grade Scoring Table: Grade 5 - No response (intermediate signal intensity, same appearances as original tumour) Grade 4 - Slight response (little areas of fibrosis or mucin but mostly tumour) Grade 3 - Moderate response (\>50% fibrosis or mucin, and visible intermediate signal) Grade 2 - Good response (dense fibrosis; no obvious residual tumour, signifying minimal residual disease or no tumour) Grade 1 - Radiological complete response (rCR) (linear/crescentic 1-2mm scar in mucosa or submucosa only.)

Pelican Cancer Foundation

Royal Marsden NHS Foundation Trust

Symptoms and General Pathology

Recurrence

Postoperative Complications

Neoplasm Recurrence, Local

Disease Attributes

Neoplastic Processes

patients underwent cylindrical abdominoperineal resection for advanced very low rectal cancer

patients underwent conventional abdominoperineal resection for advanced very low rectal cancer

Extended abdominoperineal resection with human acellular dermal matrix reconstruction of the pelvic floor for rectal cancer

cylindrical abdominoperineal resection

Zhen Jun Wang, M.D.

Jia Gang Han, M.D.

Jian Hua Cai, M.D.

Hua Chong Ma, M.D.

Yan Fu Du, M.D.

Min Zhe Li, M.D.

Wei Tang Yuan, M.D.

Qun Qian, M.D.

Xian Dong Zeng, M.D.

Yong Dai, M.D.

Heng Ma, M.D.

The purpose of this study is to determine whether cylindrical abdominoperineal resection is effective in the treatment of advanced very low rectal cancer

Abdominoperineal resection (APR) is still a common operation in patients with tumours less than 6 cm from the anal verge. The perineal phase of APR is a difficult part of the operation, often done with the patient in the supine position.The risk of inadvertent bowel perforation is high, the resulting specimen frequently has a waist at the lower border of the mesorectum, and the circumferential resection margin (CRM) is often close to the rectal muscle tube. The cylindrical APR may be performed via an extended posterior perineal approach, that aims to create a more cylindrical specimen without a waist. The potential benefit of this technique is a reduction in the risk of bowel perforation and tumour involvement of the CRM, and thus in the risk of local recurrence.

Perineal wounds in patients following APR are at considerable risk for infection, dehiscence and delayed healing when closed primarily. This can be further increased in patients who have received neoadjuvant chemoradiation therapy. The adoption of extended resection, such as the cylindrical APR, may cause additional risks. The use of acellular biomaterials, including human acellular dermal matrix (HADM) has drawn great interest for the complex abdominal wall reconstruction.

The purpose of this study is to determine whether cylindrical abdominoperineal resection is effective in the treatment of advanced very low rectal cancer, and to determine the initial results of pelvic reconstruction using human acellular dermal matrix after cylindrical abdominoperineal resection.

circumferential resection margin; bowel perforation; cross sectional tissue area outside the internal sphincter; mean distance from the internal sphincter to the anterior, posterior and lateral circumferential resection margins

Safety and Efficacy Study of Cylindrical Abdominoperineal Resection to Treat Rectal Cancer

A Randomized, Controlled, Multicenter Trial to Evaluate the Safety and Efficacy of Cylindrical Abdominoperineal Resection in the Treatment of Advanced Very Low Rectal Cancer

Shandong Provincial Hospital

Shandong Cancer Hospital and Institute

The First Affiliated Hospital of Zhengzhou University

Wuhan University

Shenyang Anorectal Hospital

Beijing Luhe Hospital

Beijing Chao Yang Hospital

Professor and Head of General Surgery

For T3N1-2M0 rectal cancer with negative circumferential resection margin based on MRI assessment, recieve surgery without neoadjuvant chemoradiotherapy.

For T3N1-2M0 rectal cancer with negative circumferential resection margin based on MRI assessment, recieve surgery following neoadjuvant chemoradiotherapy.

neoadjuvant chemoradiotherapy

Jiagang Han, MD

Jiagang Han, Professor

Zhenjun Wang, professor

Guanghui WEI, Professor

For now, neoadjuvant chemoradiotherapy is routinely performed for T3N1-2M0 rectal cancer. However, there are lots of complications following neoadjuvant chemoradiotherapy, such as Wound-related complications, anastomotic leakage, anastomotic stenosis, sexual dysfunction, testicular or ovary failure. Patients undergoing resection for rectal cancer had low rates of local recurrence and long disease-free survival regardless of whether an APR, CAA or low AR was performed. The main purpose of preoperative radiotherapy is to lower the local recurrence. For the T3N1-2M0 rectal cancer with negative circumferential resection margin based on MRI assessment, we suppose might not necessary to receive neoadjuvant chemoradiotherapy, for operation can achieve the negative circumferential resection margin.

Surgery Without Neoadjuvant Chemoradiotherapy Compared With Neoadjuvant Chemoradiotherapy for Rectal Cancer With Negative Circumferential Resection Margin Based on MRI Assessment, a Perspective Multicenter Randomized Controlled Trial

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Molecular, Pathologic and MRI Investigation of the Prognostic and Redictive Importance of Extramural Venous Invasion in Rectal Cancer (MARVEL) Trial	NCT01995942	Adenocarcinoma Rectal Diseases Colorectal Neop... Adenocarcinoma,... Carcinoma Neoplasms, Glan... Neoplasms by Hi... Neoplasms Neoplasms, Cyst... Intestinal Neop... Gastrointestina... Digestive Syste... Neoplasms by Si... Digestive Syste... Gastrointestina... Intestinal Dise...		18 Years -	Royal Marsden NHS Foundation Trust
Safety and Efficacy Study of Cylindrical Abdominoperineal Resection to Treat Rectal Cancer	NCT00949273	Rectal Cancer Treatment Postoperative C... Neoplasm Recurr... Survival Rate	cylindrical abd...	18 Years - 80 Years	Beijing Chao Yang Hospital
Surgery Without Neoadjuvant Chemoradiotherapy Compared With Neoadjuvant Chemoradiotherapy for Rectal Cancer With Negative Circumferential Resection Margin Based on MRI Assessment, a Perspective Multicenter Randomized Controlled Trial	NCT03504449	Circumferential... Intraoperative ... Local Recurrenc... Disease-free Su... Overal Survival	neoadjuvant che...	18 Years - 75 Years	Beijing Chao Yang Hospital
Surgery Without Neoadjuvant Chemoradiotherapy Compared With Neoadjuvant Chemoradiotherapy for Rectal Cancer With Negative Circumferential Resection Margin Based on MRI Assessment, a Perspective Multicenter Randomized Controlled Trial	NCT03504449	Circumferential... Intraoperative ... Local Recurrenc... Disease-free Su... Overal Survival	neoadjuvant che...	18 Years - 75 Years	Beijing Chao Yang Hospital

Spots Global Cancer Trial Database for circumferential resection margin