Zhangyuanzhu Liu, Dexin Chen, Wei Jiang, Kai Li, Xiumin Liu, Jun Yan. Department of General Surgery, Nanfang Hospital, Southern Medical University
Background and Objective: In low rectal cancer, a negative distal margin is necessary for R0 redical resection and therefore surgical procedure choosing should consider whether the planned transection rectum has cancer residual. Currently, surgeons make decision and choose surgical procedure according to intraoperative frozen section, which is helpful in judging negative or positive distal margin. There is lack of a real-time in vivo examination to evaluate DM in situ.The purpose of this study was to investigate the feasibility of real-time in vivo optical biopsy using confocal laser endomicroscopy (CLE) to evaluate distal margin in situ and determine surgical procedure in low rectal cancer.
Methods: Opitical biopsy using real-time in vivo CLE were performed when rectum was dissected at the levator ani plane and rectum transection was ready. For negative distal margin in planned transection rectum, surgical procedure of low anterior resection (LAR) was chosen. For positive distal margin in planned transection rectum, surgical procedure of abdominoperineal resection (APR) was chosen. Specimen at the site of planned transection rectum was underwent intra-operative frozen section and routine pathological procedures.. CLE images were compared with H-E stainning images.
Results: 17 low rectal cancer patients underwent real-time in vivo optical biopsy using CLE in surgery. 11 patients’ CLE images of DM showed regular, round crypt and round luminal opening covered by a simple layer of columnar epithelial cells, including goblet cells (Fig.A-C), then LAR were performed. H-E staining pathology revealed that the 11 DMs were negative and the average distance of distal margin was 2.7cm. The rest 6 patients’ CLE images of planned transection rectum showed loss of crypt architecture, irregular epithelial layer with loss of goblet cells (Fig. D-F), then APR were performed. H-E staining pathology of planned transection rectum confirmed cancer invasion and the average distance from tumor to dentate line were 1.0cm. The sensitivity, specificity and accuracy of CLE optical biopsy of DM were 83%, 100% and 94% respectively.
Conclusions: It is feasible to perform real-time in vivo optical biopsy using CLE to evaluate distal margin in situ and determine surgical procedure in low rectal cancer.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87563
Program Number: S120
Presentation Session: Colorectal 2 Session
Presentation Type: Podium