MRI-detected extramural vascular invasion is the most powerful predictor of systemic recurrence in locally advanced rectal cancer. Implications for total neoadjuvant strategies planning.

Abstract

Background: Chemotherapy in locally advance rectal cancer (LARC) is shifting from an adjuvant setting to a total neoadjuvant therapy (TNT) strategy. However, we still lack easily available preoperative parameters truly identifying the group of patients at high risk of systemic recurrence. MRI-detected extramural vascular invasion (mrEMVI) is increasingly emerging as the best predictor of distant metastasis (DM) development. We hereby analyzed the relationship between mrEMVI, its pathological counterpart (pEMVI), and the development of DM in a single-center series of resected rectal cancers.