Objective To retrospectively analyze the data of rectal high-resolution magnetic resonance examination before radical resection in patients with rectal cancer,observe the structure of lateral mesorectum and analyze its influence on the prognosis of patients combined with clinical data.Methods Data of patients who underwent radical resection at the First Affiliated Hospital of Naval Medical University between January 2017 and December 2018 were retrospectively analyzed.The imaging data of patients undergoing rectal high-resolution magnetic resonance imaging(MRI)before surgery were collected.The bilateral structures of the mesorectal fascia(MRF)and the middle rectal artery(MRA)were observed based on MRI,and measured its relevant parameters,including the width of the lateral mesorectum,the type of MRA and maximum diameter of MRA.Cox regression analysis was performed by combining the clinical data with the patient's disease-free survival(DFS)data.The preoperative prediction model was constructed and Nomogram and receiver operating characteristic(ROC)curves were plotted.Results This study included 258 patients.The interruption of MRF and the MRA through were observed bilaterally in all patients on preoperative rectal high-resolution MRI.MRA could be divided into 4 types:anterolateral type,lateral type,posterolateral type,and small branches type.Patients were divided into two groups according to whether local recurrence and distant metastasis occurred.Multivariate Cox regression analysis showed the maximum diameter of the right MRA(HR:3.042,95％CI:1.928～4.798,P＜0.001)and mrT stage(HR:3.618,95％CI:1.223～10.705,P=0.021)and the width of right MRF(HR:1.001,95％CI:1.000～1.001,P=0.012)were predictors of postoperative recurrence and metastasis.The C-index of the Nomogram prediction model was 0.733(95％CI:0.686～0.781).The AUC for 1-,3-and 5-year DFS was 0.784,0.808 and 0.888,respectively.Conclusion The inherent presence of the MRF and the MRA could be observed by high-resolution rectal MRI.The width of the right MRF and the maximum diameter of the right MRA were prognostic factors for postoperative recurrence and metastasis.Better intraoperative management of the MRF may lead to better outcomes for patients,and further research is still needed in the future.
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