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codi.13915

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Accepted Article
Article type
: Correspondence
653-2017
Correspondence
Assessment of the IMV diameter as a surrogate marker to evaluate response to
neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma
Authors:
1. Akinfemi Ayobami Akingboye MBBS, MRCS MD(res) {1,2} – ( Visiting clinical
fellowship at Royal Devon & Exeter Hospital, Exeter, UK
2. Niroshini Rajaretnam MBBS,MRCS -(Surgical Registrar at the Royal Devon &Exeter
,UK {1}
3. MRCS 1, Ian R. Daniels MBBS,FRCS {1} ( Consultant surgeon at the Royal Exeter
Devon& Exeter, UK{1}
1. Department of General surgery, Royal Devon & Exeter NHS Foundation Trust
Barrack Road, Exeter, Devon, EX2 5DW
2. Department of General Surgery, Colchester Hospital University Foundational Trust,
Colchester, Turner Road , CO4 5JL
Corresponding Author: Mr. Akinfemi. A. Akingboye
Email address: a.akingboye@nhs.net
Website: akinfemi.akingboye.com
Current institution: Colchester Hospital University Foundational Trust
Department of General Surgery, Turner Road, Colchester
Essex, CO4 5JL
This article has been accepted for publication and undergone full peer review but has not
been through the copyediting, typesetting, pagination and proofreading process, which may
lead to differences between this version and the Version of Record. Please cite this article as
doi: 10.1111/codi.13915
This article is protected by copyright. All rights reserved.
Accepted Article
Dear Editor,
We read with interest the paper by Ivan CV et al (1) assessing the relationship between inferior
mesenteric vein diameter and evidence of extra-mural invasion (EMVI) in rectal cancer. Recent
literature has focused on the identification of EMVI on the pre-treatment MRI due to its presence
being a major determinant and an important prognostic independent factor for risk stratification of
local and distant recurrence [2, 3]. The authors have based their hypothesis and the rationale for
using inferior mesenteric vein (IMV) measurement on the emerging evidence that suggested that a
correlation existed between splanchnic venous circulation, colorectal cancer and EMVI [3] However,
we would expect the authors to validate the IMV diameter measurement with the use of
histopathological whole mount sections as the gold standard comparing irradiated rectums with
non-cancer specimens looking at vessel change. The authors do not indicate whether the second
measurement was performed within the radiotherapy field and therefore whether this has an
impact on the subsequent diameter, compared to controls who have not had chemoradiotherapy or
cancer. Given the outcome in relation to the tumour regression grade, this leads us to question the
significance of the change in relationship to tumour response or whether this relates to flow and
pressure and vessel elasticity given the pre-operative treatment.
References
1. Ivan CV, Mullineux JH, Verma R, et al. Assessment of the IMV diameter as a surrogate marker to
evaluate response to neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma.
Colorectal Dis doi: 10.1111/codi.13811
2. Bugg WG, Andreou AK, Biswas D, Toms AP, Williams SM. The prognostic significance of MRIdetected extramural venous invasion in rectal carcinoma. Clin Radiol. 2014 Jun;69 (6):619-23. doi:
10.1016/j.crad.2014.01.010. Epub 2014 Feb 26.
This article is protected by copyright. All rights reserved.
Accepted Article
3. Thomson E, Scott N, Tolan D. Re: the prognostic significance of MRI detected extramural venous
invasion in rectal carcinoma. Clin Radiol. 2015 Jan;70 (1):111-2. doi: 10.1016/j.crad.2014.10.003.
Epub 2014 Nov 15.
This article is protected by copyright. All rights reserved.
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