title: Current practice in preoperative therapy and surgical management of locally advanced rectal cancer: a bi-national survey.
abstract: OBJECTIVE
  The Australasian colorectal surgeon's current approach to preoperative rectal cancer management was compared with international guidelines.
  
  
  METHODS
  Members of the Colorectal Surgical Society of Australia and New Zealand were surveyed in 2010, on the use of MRI and the management of locally advanced rectal cancer. Surgeons had to decide the appropriate management in five scenarios that were developed from national guidelines.
  
  
  RESULTS
  Of 174 invitations sent, 108 (62.1%) replies were received. Most surgeons (98.1%) had access to MRI. Ninety-three (86.1%) would use MRI routinely for staging. The majority selected a tumour-specific mesorectal resection for upper rectal cancer (58.2%) and a total mesorectal excision for distal cancer (100%). Almost all restorative operations included a covering ileostomy. One third of surgeons recommended that patients with a favourable cT3 mid-rectal tumour (N0, clear circumferential resection margins) should not have preoperative therapy and should proceed directly to surgery. When high-risk features, such as threatened resection margins or cN1 stage, were present, 5% and 15% of surgeons, respectively, would continue to treat by standard resection without preoperative therapy.
  
  
  CONCLUSIONS
  Evidence-based international guidelines for the management of rectal cancer have changed little in the last 10 years. Despite this, there is a clear gap between these and clinical practice. The main variance relates to the role of radiotherapy in locally advanced rectal cancer. Despite considerable evidence that radiotherapy reduces local recurrence for all stages of rectal cancer, current practice in Australasia is for its selective use.
authors: Colorectal Unit, Department of Surgery, Western Hospital, Melbourne, Victoria, Australia. kck_ooi@yahoo.com
authors: K
authors: K
authors: Ooi
authors: F
authors: F
authors: Frizelle
authors: E
authors: E
authors: Ong
authors: I
authors: I
authors: Faragher
mesh_terms: D001315:Australia; D019983:Guideline Adherence; D006801:Humans; D007081:Ileostomy; D008279:Magnetic Resonance Imaging; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009520:New Zealand; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology* / Q000628:therapy*; D011795:Surveys and Questionnaires