How Is Rectal Cancer Managed: a Survey Exploring Current Practice Patterns in Canada.

Area of Science:

• Oncology
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Locally advanced rectal cancer management typically involves neoadjuvant chemoradiation followed by surgery.
• Current practices exhibit a lack of consensus on optimal timing between treatments and managing complete clinical response.
• This study investigates current rectal cancer management trends among Canadian surgeons.

Purpose of the Study:

• To summarize and analyze current rectal cancer management trends in Canada.
• To identify variations in surgical timing, technique, and treatment strategies for complete clinical response.

Main Methods:

• A 14-question survey was emailed to 115 Canadian surgeons specializing in rectal cancer.
• Surgeons were identified through membership lists of the Canadian Association of General Surgeons and the Canadian Society of Colon and Rectal Surgeons.
• Response rate was 38.4%.

Main Results:

• All surgeons utilize magnetic resonance imaging (MRI) for staging; 50% present cases at multidisciplinary conferences.
• Minimally invasive techniques are common, but transanal total mesorectal excision (taTME) is infrequently used.
• Most surgeons prefer 8-10 weeks between chemoradiation and surgery; management of complete clinical response varies significantly, with <5% using 'watch and wait' universally.

Conclusions:

• Canadian surgeons widely use MRI for staging and engage in multidisciplinary discussions.
• Adoption of advanced minimally invasive techniques like taTME is limited.
• Significant variability exists in treatment intervals and complete clinical response management, indicating a need for standardized rectal cancer protocols.