Definition of the Rectum: An International, Expert-based Delphi Consensus.

Fecha de publicación: 08/04/2019 Fecha Ahead of Print: 08/04/2019

Autores de INCLIVA

Andrés Cervantes Ruiperez

Autor

Participantes ajenos a INCLIVA

D'Souza N
de Neree Tot Babberich MPM
d'Hoore A
Tiret E
Xynos E
Beets-Tan RGH
Nagtegaal ID
Blomqvist L
Holm T
Glimelius B
Lacy A
Glynne-Jones R
West NP
Perez RO
Quadros C
Lee KY
Madiba TE
Wexner SD
Garcia-Aguilar J
Sahani D
Moran B
Tekkis P
Rutten HJ
Tanis PJ
Wiggers T
Brown G

Grupos y Plataformas de I+D+i

Grupo de Investigación en Cáncer Colorrectal y Nuevos Desarrollos Terapéuticos en Tumores Sólidos

Leading Researcher

Andrés Cervantes Ruiperez

Abstract

Background: 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. Methods: The consensus was conducted using the Delphi technique with multidisciplinary colorectal experts from October, 2017 to April, 2018. Results: 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. Conclusion: An international consensus definition for the rectumis 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.

© 2019 Wolters Kluwer Health, Inc. All rights reserved. This is an author produced version of a paper published in Annals of Surgery. Uploaded in accordance with the publisher's self-archiving policy under the terms of the CC-BY-NC licence; https://creativecommons.org/licenses/by-nc/4.0/. Available online in its final published format; https://doi.org/10.1097/SLA.0000000000003251

Datos de la publicación

ISSN/ISSNe:: 0003-4932, 1528-1140
Tipo:: Article
Páginas:: 955-959
DOI:: 10.1097/SLA.0000000000003251
PubMed:: 30973385

Documentos

Published Version CC BY-NC-ND

Métricas

Filiaciones

Keywords

anatomy; MRI; rectum; sigmoid

Campos de Estudio

Financiación

INSTITUTO SALUD CARLOS III (PI15/02180)

Proyectos y Estudios Clínicos

Enfermedad mínima residual en cánceres colorrectales de alto riesgo resecados. Valor de las biopsias líquidas en el seguimiento y análisis de la heterogeneidad tumoral.

Investigador Principal: ANDRÉS CERVANTES RUIPEREZ

PI15/02180 . INSTITUTO SALUD CARLOS III . 2016