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Ann Surg. 2019 Apr 8. doi: 10.1097/SLA.0000000000003251. [Epub ahead of print]

Definition of the Rectum: An International, Expert-based Delphi Consensus.

Author information

1
Croydon University Hospital, London, UK.
2
Royal Marsden NHS Foundation Trust, London, UK.
3
Imperial College, London, UK.
4
Amsterdam University Medical Centers, University of Amsterdam, the Netherlands.
5
University Clinic Leuven, Belgium.
6
Hospital Saint Antoine, Paris, France.
7
Interclinic Hospital of Heraklion, Greece.
8
The Netherlands Cancer Institute, Amsterdam, the Netherlands.
9
Radboud Medical Centre, Nijmegen, the Netherlands.
10
Karolinska University Hospital, Stockholm, Sweden.
11
Uppsala University, Sweden.
12
Hospital Clinic, Barcelona, Spain.
13
CIBERONC, Biomedical Research Institute INCLIVA, University of Valencia.
14
Mount Vernon Hospital, London, UK.
15
University of Leeds, UK.
16
University of Sao Paulo School of Medicine, Brazil.
17
Aristides Maltez Hospital, Salvador, Brazil.
18
Kyung Hee University Medical Centre, Seoul, South Korea.
19
University of Kwa-Zulu Natal, South Africa.
20
Cleveland Clinic Florida, FL.
21
Memorial Sloan-Kettering Cancer Center, New York, USA.
22
Massachussets General Hospital, Boston, MA.
23
Basingstoke Hospital, UK.
24
Catherina Ziekenhuis, Eindhoven, the Netherlands.
25
GROW: School of Developmental Biology and Oncology, University of Maastricht, the Netherlands.
26
University Medical Center Groningen, Groningen, The Netherlands.

Abstract

MINI: A radiological, anatomic distinction between the rectum and sigmoid colon was agreed by consensus of international experts in rectal cancer using the Delphi Technique. Use of this landmark, "the sigmoid take-off," may harmonize efforts in research and clinical practice to improve patient outcomes.

BACKGROUND:

The wide global variation in the definition of the rectum has led to significant inconsistencies in trial recruitment, clinical management, and outcomes. Surgical technique and use of preoperative treatment for a cancer of the rectum and sigmoid colon are radically different and dependent on the local definitions employed by the clinical team. A consensus definition of the rectum is needed to standardise treatment.

METHODS:

The consensus was conducted using the Delphi technique with multidisciplinary colorectal experts from October, 2017 to April, 2018.

RESULTS:

Eleven different definitions for the rectum were used by participants in the consensus. Magnetic resonance imaging (MRI) was the most frequent modality used to define the rectum (67%), and the preferred modality for 72% of participants. The most agreed consensus landmark (56%) was "the sigmoid take-off," an anatomic, image-based definition of the junction of the mesorectum and mesocolon. In the second round, 81% of participants agreed that the sigmoid take-off as seen on computed tomography or MRI achieved consensus, and that it could be implemented in their institution. Also, 87% were satisfied with the sigmoid take-off as the consensus landmark.

CONCLUSION:

An international consensus definition for the rectum is the point of the sigmoid take-off as visualized on imaging. The sigmoid take-off can be identified as the mesocolon elongates as the ventral and horizontal course of the sigmoid on axial and sagittal views respectively on cross-sectional imaging. Routine application of this landmark during multidisciplinary team discussion for all patients will enable greater consistency in tumour localisation.

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