title: Multimodal preoperative evaluation system in surgical decision making for rectal cancer: a randomized controlled trial.
abstract: OBJECTIVE
  Multimodal preoperative evaluation (MPE) is a novel strategy for surgical decision making, incorporating the transrectal ultrasound (TRUS), 64 multi-slice spiral computer tomography (MSCT), and serum amyloid A protein (SAA) for rectal cancer. This trial aims to determine the accuracy of MPE in preoperative staging and its role in surgical decision making for rectal cancer.
  
  
  METHODS
  Two hundred twenty-five participants with histologically proven rectal cancer with tumor height less than 10 cm were randomly assigned into three arms in the ratio 1:1:1. Arm A (MPE) was multimodal staged by the combination of MSCT, TRUS, and SAA. Arm B (MSCT+SAA) was staged by MSCT and SAA. Arm C (MSCT) was staged only by MSCT. The primary endpoints were the accuracy of preoperative staging and expected surgical procedures. This study is registered as an International Standard Randomised Controlled Trial, number ChiCTR-DT-00000409.
  
  
  RESULTS
  The analysis showed statistical difference in the accuracy of T staging between arm A and B (94.6% vs. 77.8%, P=0.003) and arm A and C (94.6% vs. 80.6%, P=0.010). Statistical difference was also observed between the accuracies of preoperative N staging between arm A and C (85.1% vs. 69.4%, P=0.023) and arm A and B (85.1% vs. 84.7%, P=0.029). Surgical decision making in arm A was more accurate than that in arm C (95.9% vs. 80.6%, P=0.001). Pathological T stage (P<0.001), N stage (P<0.001), tumor node metastasis stage (P<0.001), serum level of SAA (P=0.002), and tumor height (P=0.030) were significantly associated with final surgical procedures.
  
  
  CONCLUSIONS
  MPE is an effective strategy in preoperative staging and more accurate than other available strategies in surgical decision making for rectal cancer.
authors.affiliation: Anal-Colorectal Surgery, West China Hospital, Sichuan University, 37, Guo Xue Xiang, Chengdu, China.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Wang
authors.forename: Donghao
authors.initials: D
authors.lastname: Lv
authors.forename: Huan
authors.initials: H
authors.lastname: Song
authors.forename: Lei
authors.initials: L
authors.lastname: Deng
authors.forename: Qiang
authors.initials: Q
authors.lastname: Gao
authors.forename: Junhua
authors.initials: J
authors.lastname: Wu
authors.forename: Yingyu
authors.initials: Y
authors.lastname: Shi
authors.forename: Li
authors.initials: L
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003657:Decision Making; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011182:Postoperative Care; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult