Augestad Knut M, Lindsetmo Rolv-Ole, Stulberg Jonah, Reynolds Harry, Senagore Anthony, Champagne Brad, Heriot Alexander G, Leblanc Fabien, Delaney Conor P
Division of Colorectal Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106-5047, USA.
World J Surg. 2010 Nov;34(11):2689-700. doi: 10.1007/s00268-010-0738-3.
Little is known regarding variations in preoperative treatment and practice for rectal cancer (RC) on an international level, yet practice variation may result in differences in recurrence and survival rates.
One hundred seventy-three international colorectal centers were invited to participate in a survey of preoperative management of rectal cancer.
One hundred twenty-three (71%) responded, with a majority of respondents from North America, Europe, and Asia. Ninety-three percent have more than 5 years' experience with rectal cancer surgery. Fifty-five percent use CT scan, 35% MRI, 29% ERUS, 12% digital rectal examination and 1% PET scan in all RC cases. Seventy-four percent consider threatened circumferential margin (CRM) an indication for neoadjuvant treatment. Ninety-two percent prefer 5-FU-based long-course neoadjuvant chemoradiation therapy (CRT). A significant difference in practice exists between the US and non-US surgeons: poor histological differentiation as an indication for CRT (25% vs. 7.0%, p = 0.008), CRT for stage II and III rectal cancer (92% vs. 43%, p = 0.0001), MRI for all RC patients (20% vs. 42%, p = 0.03), and ERUS for all RC patients (43% vs. 21%, p = 0.01). Multidisciplinary team meetings significantly influence decisions for MRI (RR = 3.62), neoadjuvant treatment (threatened CRM, RR = 5.67, stage II + III RR = 2.98), quality of pathology report (RR = 4.85), and sphincter-saving surgery (RR = 3.81).
There was little consensus on staging, neoadjuvant treatment, and preoperative management of rectal cancer. Regular multidisciplinary team meetings influence decisions about neoadjuvant treatment and staging methods.
在国际层面上，关于直肠癌（RC）术前治疗和实践的差异所知甚少，但实践差异可能导致复发率和生存率的差异。
邀请了173个国际结直肠中心参与直肠癌术前管理的调查。
123个中心（71%）做出了回应，大多数受访者来自北美、欧洲和亚洲。93%的受访者有超过5年的直肠癌手术经验。在所有直肠癌病例中，55%使用CT扫描，35%使用MRI，29%使用内镜超声（ERUS），12%使用直肠指检，1%使用PET扫描。74%的人认为环周切缘（CRM）受威胁是新辅助治疗的指征。92%的人更喜欢基于5-氟尿嘧啶（5-FU）的长疗程新辅助放化疗（CRT）。美国外科医生和非美国外科医生在实践中存在显著差异：低分化组织学作为CRT的指征（25%对7.0%，p = 0.008），II期和III期直肠癌的CRT（92%对43%，p = 0.0001），所有直肠癌患者使用MRI（20%对42%，p = 0.03），以及所有直肠癌患者使用ERUS（43%对21%，p = 0.01）。多学科团队会议对MRI决策（RR = 3.62）、新辅助治疗（CRM受威胁，RR = 5.67，II + III期RR = 2.98）、病理报告质量（RR = 4.85）和保肛手术（RR = 3.81）有显著影响。
在直肠癌的分期、新辅助治疗和术前管理方面几乎没有共识。定期的多学科团队会议会影响新辅助治疗和分期方法的决策。
