International trends in surgical treatment of rectal cancer

BACKGROUND: Surgical technique might influence rectal cancer survival, yet international practices for surgical treatment of rectal cancer are poorly described. METHODS: We performed a cross-sectional survey in a cohort of experienced colorectal surgeons representing 123 centers. RESULTS: Seventy-one percent responded, 70% are from departments performing more than 50 proctectomies annually. More than 50% defined the rectum as 15 cm from the verge. Seventy-two percent perform laparoscopic proctectomy, 80% use oral bowel preparation, 69% perform high ligation of the inferior mesenteric artery, 76% divert stomas as routine for cob-anal anastomosis, and 63% use enhanced recovery protocols. Different practices exist between US and non-US surgeons: 15 cm from the verge to define the rectum (34% vs 59%; P = .03), personally perform laparoscopic resection (82% vs 66%; P = .05), rectal stump washout (36% vs 73%; P = .0001), always drain after surgery (23% vs 42%; P = .03), transanal endoscopic microsurgery for T2NO in medically unfit patients (39% vs 61%; P = .0001). CONCLUSIONS: Wide international variations in rectal cancer management make outcome comparisons challenging, and consensus development should be encouraged. (C) 2011 Elsevier Inc. All rights reserved.