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The rectosigmoid problem.

Nigel D'Souza1, M P M de Neree Tot Babberich2, Amy Lord1

  • 1Royal Marsden Hospital, Downs Road, Sutton, UK; Croydon University Hospital, London Road, Croydon, UK.

Surgical Oncology
|September 16, 2018
PubMed
Summary

Defining the rectosigmoid junction is crucial for accurate cancer classification and treatment. This review proposes the "sigmoid take-off" as a reliable anatomical landmark to improve consistency in patient management.

Keywords:
AnatomyColorectal cancerMagnetic resonance imagingNeoadjuvantRectumSigmoid

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Area of Science:

  • Colorectal Surgery
  • Surgical Anatomy
  • Oncology

Background:

  • Lack of consensus on the rectosigmoid junction definition impacts colorectal cancer diagnosis and treatment.
  • Inconsistent tumor localization leads to suboptimal patient management, including under or overtreatment.
  • The rectosigmoid junction is now recognized as a distinct segment by the International Classification of Diseases, increasing the need for a standardized definition.

Purpose of the Study:

  • To review existing landmarks for the rectosigmoid junction.
  • To evaluate the strengths and weaknesses of current definitions.
  • To propose a reliable anatomical landmark for consistent rectosigmoid junction identification.

Main Methods:

  • Comprehensive literature review of anatomical landmarks for the rectosigmoid junction.
  • Analysis of theoretical and evidence-based strengths and weaknesses of each landmark.
  • Identification and description of a novel, anatomical landmark: the sigmoid take-off.

Main Results:

  • Existing landmarks for the rectosigmoid junction lack consensus and reliability.
  • Inconsistent classification of sigmoid and rectal cancers has significant clinical implications.
  • The "sigmoid take-off" is presented as a bespoke, anatomical, and reliable landmark.

Conclusions:

  • A standardized definition of the rectosigmoid junction is essential for accurate colorectal cancer classification.
  • The proposed "sigmoid take-off" landmark can enhance consistency in patient management and research.
  • Adoption of this landmark may reduce treatment disparities and improve outcomes for patients with sigmoid and rectal cancers.