The American Society of Colon and Rectal Surgeons is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Standards Committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This Committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient.

Practice parameters for the management of rectal cancer (revised)

With the widespread introduction of preoperative radiotherapy for rectal cancer and the development of transanal endoscopic microsurgery for selected early lesions, preoperative radiological staging of these tumours has taken on increasing importance. This study is a systematic review to evaluate computed tomography (CT), endorectal sonography (ES) and magnetic resonance imaging (MRI) as preoperative staging modalities in rectal cancer. A Medline-based search identifying studies using CT, ES, or MRI in preoperative staging of rectal cancer between 1980 and 1998 was undertaken. The list of papers was supplemented by extensive cross-checking of citation lists. Studies were included if they met predetermined criteria. Data from the accepted studies were entered into pooled tables comparing radiological and pathological staging results for each modality both in determining bowel wall penetration and involvement of lymph nodes. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were determined for the pooled results. Eighty-three studies from 78 papers including 4,897 patients met the inclusion criteria. In determining the wall penetration of the tumour the values for sensitivity for CT, ES, MRI and MRI with endorectal coil were 78%, 93%, 86% and 89%; for specificity 63%, 78%, 77% and 79%; and for accuracy 73%, 87%, 82% and 84%, respectively. In determining the nodal involvement by tumour the sensitivity values for CT, ES, MRI and MRI with endorectal coil 52%, 71%, 65% and 82%; for specificity 78%, 76%, 80% and 83%; and for accuracy 66%, 74%, 74% and 82%, respectively. MRI with an endorectal coil is the single investigation that most accurately predicts pathological stage in rectal cancer.

Preoperative staging of rectal cancer.

Objective:We examined the prognostic impact of lymph node ratio (relation of tumor-infiltrated to resected lymph nodes) in comparison to the pN category and other prognostic factors in patients with colorectal cancer.Summary Background Data:Although the high prognostic impact of lymph node metastase

Prognosis of patients with colorectal cancer is associated with lymph node ratio: a single-center analysis of 3,026 patients over a 25-year time period.

https://www.gastrojournal.org/article/S0016-5085(02)00060-4/pdf

A prospective, blinded assessment of the impact of preoperative staging on the management of rectal cancer.

Daniel Otchy, M.D., Neil H. Hyman, M.D., Clifford Simmang, M.D., Thomas Anthony, M.D., W. Donald Buie, M.D., Peter Cataldo, M.D., James Church, M.D., Jeffrey Cohen, M.D., Frederick Dentsman, M.D., C. Neal Ellis, M.D., John W. Kilkenny III, M.D., Clifford Ko, M.D., Richard Moore, M.D., Charles Orsay, M.D., Ronald Place, M.D., Janice Rafferty, M.D., Jan Rakinic, M.D., Paul Savoca, M.D., Joe Tjandra, M.D., Mark Whiteford, M.D.

S Mehta

Papers

Staging of colorectal cancer.