Advertisement

International trends in surgical treatment of rectal cancer

      Abstract

      Background

      Surgical technique might influence rectal cancer survival, yet international practices for surgical treatment of rectal cancer are poorly described.

      Methods

      We performed a cross-sectional survey in a cohort of experienced colorectal surgeons representing 123 centers.

      Results

      Seventy-one percent responded, 70% are from departments performing more than 50 proctectomies annually. More than 50% defined the rectum as “15 cm from the verge.” Seventy-two percent perform laparoscopic proctectomy, 80% use oral bowel preparation, 69% perform high ligation of the inferior mesenteric artery, 76% divert stomas as routine for colo-anal anastomosis, and 63% use enhanced recovery protocols. Different practices exist between US and non-US surgeons: 15 cm from the verge to define the rectum (34% vs 59%; P = .03), personally perform laparoscopic resection (82% vs 66%; P = .05), rectal stump washout (36% vs 73%; P = .0001), always drain after surgery (23% vs 42%; P = .03), transanal endoscopic microsurgery for T2N0 in medically unfit patients (39% vs 61%; P = .0001).

      Conclusions

      Wide international variations in rectal cancer management make outcome comparisons challenging, and consensus development should be encouraged.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ward J.E.
        • Gattellari M.
        • Solomon M.J.
        Management of patients with colorectal cancer: do Australian surgeons know the scientific evidence?.
        Arch Surg. 2002; 137: 1389-1394
        • Slim K.
        • Panis Y.
        • Chipponi J.
        Half of the current practice of gastrointestinal surgery is against the evidence: a survey of the French Society of Digestive Surgery.
        J Gastrointest Surg. 2004; 8: 1079-1082
        • Engstrom P.F.
        • Arnoletti J.P.
        • Benson 3rd, A.B.
        • et al.
        NCCN clinical practice guidelines in oncology: rectal cancer.
        J Natl Compr Cancer Netw. 2009; 7: 838-881
        • Heald R.J.
        • MacFarlane J.K.
        • Ryall R.D.
        Surgical lateral clearance in resected rectal carcinomas: a multivariate analysis of clinicopathologic features.
        Cancer. 1993; 72: 1806
        • Martling A.
        • Cedermark B.
        • Johansson H.
        • et al.
        The surgeon as a prognostic factor after the introduction of total mesorectal excision in the treatment of rectal cancer.
        Br J Surg. 2002; 89: 1008-1013
        • Morgan C.N.
        • Thompson H.R.
        Surgical anatomy of the anal canal with special reference to the surgical importance of the internal sphincter and conjoint longitudinal muscle.
        Ann R Coll Surg Engl. 1956; 19: 88-114
        • Lowry A.C.
        • Simmang C.L.
        • Boulos P.
        • et al.
        Consensus statement of definitions for anorectal physiology and rectal cancer.
        Colorectal Dis. 2001; 3: 272-275
        • Augestad K.M.
        • Lindsetmo R.O.
        • Stulberg J.
        • et al.
        International preoperative rectal cancer management: staging, neoadjuvant treatment, and impact of multidisciplinary teams.
        World J Surg. 2010; 34: 2689-2700
        • Christoforidis D.
        • Cho H.M.
        • Dixon M.R.
        • et al.
        Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer.
        Ann Surg. 2009; 249: 776-782
        • Urbach D.R.
        • Kennedy E.D.
        • Cohen M.M.
        Colon and rectal anastomoses do not require routine drainage: a systematic review and meta-analysis.
        Ann Surg. 1999; 229: 174-180
        • Tan W.S.
        • Tang C.L.
        • Shi L.
        • et al.
        Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer.
        Br J Surg. 2009; 96: 462-472
        • Valentini V.
        • Aristei C.
        • Glimelius B.
        • et al.
        Multidisciplinary rectal cancer management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2).
        Radiother Oncol. 2009; 92: 148-163