Croydon University Hospital, London, UK.
Royal Marsden NHS Foundation Trust, London, UK.
Ann Surg. 2019 Dec;270(6):955-959. doi: 10.1097/SLA.0000000000003251.
The wide global variation in the definition of the rectum has led to significant inconsistencies in trial recruitment, clinical management, and outcomes. Surgical technique and use of preoperative treatment for a cancer of the rectum and sigmoid colon are radically different and dependent on the local definitions employed by the clinical team. A consensus definition of the rectum is needed to standardise treatment.
The consensus was conducted using the Delphi technique with multidisciplinary colorectal experts from October, 2017 to April, 2018.
Eleven different definitions for the rectum were used by participants in the consensus. Magnetic resonance imaging (MRI) was the most frequent modality used to define the rectum (67%), and the preferred modality for 72% of participants. The most agreed consensus landmark (56%) was "the sigmoid take-off," an anatomic, image-based definition of the junction of the mesorectum and mesocolon. In the second round, 81% of participants agreed that the sigmoid take-off as seen on computed tomography or MRI achieved consensus, and that it could be implemented in their institution. Also, 87% were satisfied with the sigmoid take-off as the consensus landmark.
An international consensus definition for the rectum is the point of the sigmoid take-off as visualized on imaging. The sigmoid take-off can be identified as the mesocolon elongates as the ventral and horizontal course of the sigmoid on axial and sagittal views respectively on cross-sectional imaging. Routine application of this landmark during multidisciplinary team discussion for all patients will enable greater consistency in tumour localisation.
直肠定义的全球范围广泛差异导致试验招募、临床管理和结果存在显著不一致。直肠癌和乙状结肠癌的手术技术和术前治疗的使用因临床团队使用的局部定义而有很大的不同。需要有一个直肠的共识定义来规范治疗。
共识是使用德尔菲技术于 2017 年 10 月至 2018 年 4 月期间由来自多学科结直肠专家进行的。
共识参与者使用了 11 种不同的直肠定义。磁共振成像（MRI）是最常用于定义直肠的方式（67%），也是 72%的参与者首选的方式。最被认可的共识地标（56%）是“乙状结肠起点”，这是直肠系膜和结肠系膜交界处的解剖学、基于图像的定义。在第二轮中，81%的参与者同意在 CT 或 MRI 上看到的乙状结肠起点达到了共识，并且可以在他们的机构中实施。此外，87%的参与者对乙状结肠起点作为共识地标感到满意。
直肠的国际共识定义是影像学上所见的乙状结肠起点。乙状结肠起点可以在横断面成像上分别在轴位和矢状位上识别为结肠系膜伸长，乙状结肠呈腹侧和水平走向。在多学科团队讨论中为所有患者常规应用这个地标将使肿瘤定位更加一致。
