A tertiary care hospital's 10 years' experience with rectal ultrasound in early rectal cancer

Abstract

Background and Objectives:Rectal endoscopic ultrasound (RUS) has become an essential tool in the management of rectal adenocarcinoma because of the ability to accurately stage lesions. The aim of this study was to identify the staging agreement of early RUS-staged rectal adenocarcinoma with surgical resected pathology and ultimately determine how this impacts the management of early rectal cancer (T1–T2).Methods:Retrospective chart review was performed from November 2002 to November 2013 to identify procedure indication, RUS staging data, surgical management, and postoperative surgical pathology data.Results:There were a total of 693 RUS examinations available for review and 282 of these were performed for a new diagnosis of rectal adenocarcinoma. There was staging agreement between RUS and surgical pathology in 19 out of 20 (95%) RUS-staged T1 cases. There was staging agreement between RUS and surgical pathology in 3 out of 9 (33%) RUS-staged T2 cases. There was significantly better staging agreement for RUS-staged T1 lesions compared to RUS staged T2 lesions (P = 0.002). Nearly 60% of T1N0 cancers were referred for transanal excisions (TAEs), and 78% of T2N0 cancers underwent low anterior resection.Conclusions:This study identified only a small number of T1–T2 adenocarcinomas. There was good staging agreement between RUS and surgical pathology among RUS-staged T1 lesions whereas poor staging agreement among RUS-staged T2 lesions. Although TAE is largely indicated by the staging of a T1 lesion, this approach may be less appropriate for T2 lesions due to high reported local recurrence.

Progress in endoscopic treatment of hemorrhoids

“…Finally, the visualization of the anorectosigmoid region during endoscopy of the patient prior to treatment, identifies other colorectal diseases that may be contributing to the symptoms such as bleeding, especially colorectal neoplasia. [ 63 , 64 , 65 ] In the United States, a cohort study based on blood in the stool reported that the incidence of diverticulosis, polyps or multiple polyps, mucosal abnormalities/colitis, tumors, and solitary ulcers were significantly increased in the patients undergoing endoscopy. [ 66 ] In addition, anorectal diseases such as hemorrhoids are very common in patients with intestinal diseases.…”

Surgical Techniques for Transanal Local Excision for Early Rectal Cancer

“…ERUS has been proposed to exhibit superior accuracy in early disease staging when compared to MRI, albeit with reduced precision in assessing lymph node involvement. Conversely, MRI demonstrates superior accuracy in assessing lymph node status compared to ERUS [9,10].…”

Management of early rectal cancer; current surgical options and future direction

“…Endo-rectal ultrasound has been suggested to offer a higher accuracy in staging early disease compared to MRI, however offers poorer accuracy for lymph node assessment. The converse is suggested to be true for MRI scanning[ 7 , 8 ]. Both modalities were suggested to over-stage early T1/T2 disease and showed poor differentiation between the two[ 9 ].…”