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Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
International trends in surgical treatment of rectal cancer
Knut M Augestad1, Rolv-Ole Lindsetmo, Harry Reynolds
1Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH 44106-5047, USA.
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.
