TY - JOUR
T1 - Definition of the Rectum: An International, Expert-based Delphi Consensus
AU - DʼSouza, Nigel
AU - de Neree tot Babberich, Michael P. M.
AU - d'Hoore, Andre
AU - Tiret, Emmanuel
AU - Xynos, Evaghelos
AU - Beets-Tan, Regina G. H.
AU - Nagtegaal, Iris D.
AU - Blomqvist, Lennart
AU - Holm, Torbjorn
AU - Glimelius, Bengt
AU - Lacy, Antonio
AU - Cervantes, Andres
AU - Glynne-Jones, Robert
AU - West, Nicholas P.
AU - Perez, Rodrigo O.
AU - Quadros, Claudio
AU - Lee, Kil Yeon
AU - Madiba, Thandinkosi E.
AU - Wexner, Steven D.
AU - Garcia-Aguilar, Julio
AU - Sahani, Dushyant
AU - Moran, Brendan
AU - Tekkis, Paris
AU - Rutten, Harm J.
AU - Tanis, Pieter J.
AU - Wiggers, Theo
AU - Brown, Gina
PY - 2019
Y1 - 2019
N2 - 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 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.
AB - 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 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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85075093966&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30973385
U2 - https://doi.org/10.1097/SLA.0000000000003251
DO - https://doi.org/10.1097/SLA.0000000000003251
M3 - Article
C2 - 30973385
SN - 0003-4932
VL - 270
SP - 955
EP - 959
JO - Annals of surgery
JF - Annals of surgery
IS - 6
ER -