Midwest Surgical Association
International trends in surgical treatment of rectal cancer

https://doi.org/10.1016/j.amjsurg.2010.08.030Get rights and content

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.

Section snippets

The study group

The International Rectal Cancer Study Group (IRCSG) is an independent group without financial support from any company or organization, with representatives from Australasia, Europe, and North America, established to evaluate current international treatment practices of rectal cancer. A group of 6 surgeons from the United States, Australia, and Europe constituted the working members of IRCSG. All surgeons in the working group had more than 10 years' experience with rectal cancer management.

Demographic background and surgical experience

Of the 173 invited participants, 123 (71%) responded. The surgeons come from 28 countries, mainly located in Europe, North America, and Australasia (Table 1). Seventy-eight percent are affiliated with a university hospital, 93% have more than 5 years' experience with rectal cancer surgery, and 70% work in departments that manage more than 50 rectal cancers per year. Seventy-three percent perform more than 20 rectal surgeries annually, and 20% perform more than 50 surgeries annually.

Terms of localization and anatomic description

A majority

Comments

This survey analyzed international practice trends among experienced colorectal surgeons regarding surgical technique and practice for surgical treatment of rectal cancer. The survey shows a wide variety of anatomic definitions of a rectal tumor, surgical techniques, indications for TEM, and use of drains and diverting stomas.

Heald et al4 have standardized the anatomic approach to rectal cancer by performing a total mesorectal excision (TME) with sharp dissection in the avascular plane

References (12)

There are more references available in the full text version of this article.

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