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Surgical techniques in the management of rectal cancer: a modified Delphi method by colorectal surgeons in Australia and New Zealand

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Abstract

Background

Technological developments have allowed advances in minimally invasive techniques for total mesorectal excision such as laparoscopy, robotics, and transanal surgery. There remains an ongoing debate about the safety, benefits, and appropriate clinical scenarios for which each technique is employed. The aim of this study was to provide a panel of expert opinion on the role of each surgical technique currently available in the management of rectal cancer using a modified Delphi method.

Methods

Surveys were designed to explore the key patient- and tumor-related factors including clinical scenarios for determining a surgeon’s choice of surgical technique.

Results

Open surgery was favoured in obese patients with an extra-peritoneal tumor and a positive circumferential resection margin (CRM) or T4 tumor when a restorative resection was planned. Laparoscopy was favoured in non-obese males and females, in both intra- and extra-peritoneal tumors with a clear CRM. Robotic surgery was most commonly offered to obese patients when the CRM was clear and if an abdominoperineal resection was planned. Transanal total mesorectal excision (taTME) was preferred in male patients with a mid or low rectal cancer, particularly when obese. Transanal endoscopic microsurgery/transanal minimally invasive surgery local excision was only offered to frail patients with small, early stage tumors.

Conclusions

All surgical techniques for rectal cancer dissection have a role and may be considered appropriate. Some techniques have advantages over others in certain clinical situations, and the best outcomes may be achieved by considering all options before applying an individualised approach to each clinical situation.

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Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Monash University, Melbourne, VIC, Australia

    S. W. Bell, S. K. Warrier & C. K. Farmer

  2. Alfred Hospital, Monash University, Melbourne, VIC, Australia

    S. W. Bell, S. K. Warrier & C. K. Farmer

  3. Division of Cancer Research, University of Melbourne, Melbourne, VIC, Australia

    A. G. Heriot, S. K. Warrier & J. C. Kong

  4. Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia

    A. G. Heriot & J. C. Kong

  5. Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Australia

    A. R. L. Stevenson

  6. Royal Brisbane and Women’s Hospital, Brisbane, Australia

    A. R. L. Stevenson

  7. Department of Surgery, University of Auckland, Auckland, 1010, New Zealand

    I. Bissett

  8. Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia

    M. Solomon

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Correspondence to S. W. Bell.

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Bell, S.W., Heriot, A.G., Warrier, S.K. et al. Surgical techniques in the management of rectal cancer: a modified Delphi method by colorectal surgeons in Australia and New Zealand. Tech Coloproctol 23, 743–749 (2019). https://doi.org/10.1007/s10151-019-02052-4

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  • DOI: https://doi.org/10.1007/s10151-019-02052-4

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