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10.1245/s10434-006-9164-z
Annals of Surgical Oncology 13:1393-1402 (2006)
© 2006 Society of Surgical Oncology
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Original Article

Neoplastic Mesorectal Microfoci (MMF) Following Neoadjuvant Chemoradiotherapy: Clinical and Prognostic Implications

Carlo Ratto, MD1, Riccardo Ricci, MD2, Vincenzo Valentini, MD3, Federica Castri, MD2, Angelo Parello, MD1, Maria A. Gambacorta, MD3, Numa Cellini, MD3, Fabio M. Vecchio, MD2 and Giovanni B. Doglietto, MD1

1 Department of Clinica Chirurgica, Catholic University, Largo A. Gemelli, 8, 00168 Rome, Italy
2 Department of Pathology, Catholic University, Largo A. Gemelli, 8, 00168 Rome, Italy
3 Department of Radiotherapy, Catholic University, Largo A. Gemelli, 8, 00168 Rome, Italy

Correspondence: Address correspondence and reprint requests to: Carlo Ratto, MD; E-mail: carloratto{at}tiscali.it

Background: Neoplastic microfoci have frequently been found in the mesorectum, with poor outcome. In this study, incidence and clinical significance of mesorectal microfoci (MMF) were analyzed in patients operated upon for rectal cancer following neoadjuvant chemoradiation.

Methods: A case series of 68 patients with extraperitoneal rectal cancer, treated with neo-adjuvant chemoradiation and surgery (including total mesorectal excision), was investigated for the presence of neoplastic MMF.

Results: Mesorectal microfoci were found in 26 cases (38.2%). Increasing incidence of microfoci was statistically related to pathologic involvement of bowel wall (P = 0.0006), Mandard’s tumor regression grading (P = 0.0006) and pathologic neoplastic mesorectal involvement (P < 0.00001). None of the nine patients with complete tumor disappearance displayed both microfoci and lymph node metastasis. Only one local recurrence developed in a patient with multiple MMF. Out of 9 pT0 or TRG1 patients, 1 (11.1%) had distant metastases, compared to 15 out of 59 pT1–4 or TRG2–5 (25.4%, P = 0.70).

Conclusions: A remarkable incidence of MMF was found following chemoradiation. However, when this therapy induces complete regression of primary tumor (pT0–TRG1), node metastases and neoplastic MMF could also disappear, as shown in our cases. These features should be confirmed because they could significantly impact the treatment decision-making of rectal cancers.

Key Words: Rectal cancer • Surgery • Chemoradiation • Local recurrence • Mesorectum






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