title: A critical appraisal of endorectal ultrasound and transanal endoscopic microsurgery and decision-making in early rectal cancer.
abstract: OBJECTIVE
  Transanal endoscopic microsurgery (TEM) for early rectal cancer (ERC) gives results similar to major surgery in selected cases. Endorectal ultrasound (ERUS) is an important part of the preoperative selection process. This study reports its accuracy and impact for patients entered on the UK TEM database.
  
  
  METHODS
  The UK TEM database comprises prospectively collected data on 494 patients. This data set was used to determine the prevalence of ERUS in preoperative staging and its accuracy by comparing preoperative T-stage with definitive pathological staging following TEM.
  
  
  RESULTS
  ERUS was performed in 165 of 494 patients who underwent TEM for rectal cancer. It inaccurately staged rectal cancer in 44.8% of tumours: 32.7% were understaged and 12.1% were overstaged. There was no significant difference in the depth of TEM excision or R1 rate between the patients who underwent ERUS before TEM and those who did not (P = 0.73).
  
  
  CONCLUSIONS
  The data show that ERUS is employed in a minority of patients with rectal cancers undergoing TEM in the UK and its accuracy in this 'Real World' practice is disappointing.
authors.affiliation: Oxford Colorectal Centre, Churchill, Oxford, UK.
authors.forename: S
authors.initials: S
authors.lastname: Ashraf
authors.forename: R
authors.initials: R
authors.lastname: Hompes
authors.forename: A
authors.initials: A
authors.lastname: Slater
authors.forename: I
authors.initials: I
authors.lastname: Lindsey
authors.forename: S
authors.initials: S
authors.lastname: Bach
authors.forename: N J
authors.initials: NJ
authors.lastname: Mortensen
authors.forename: C
authors.initials: C
authors.lastname: Cunningham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016009:Chi-Square Distribution; D016208:Databases, Factual; D003657:Decision Making; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D011351:Proctoscopy; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*