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

Nigel D'Souza; Michael P. M. de Neree Tot Babberich; Andre d'Hoore; Emmanuel Tiret; Evaghelos Xynos; Regina G. H. Beets-Tan; Iris D. Nagtegaal; Lennart Blomqvist; Torbjorn Holm; Bengt Glimelius; Antonio Lacy; Andres Cervantes; Robert Glynne-Jones; Nicholas P. West; Rodrigo O. Perez; Claudio Quadros; Kil Yeon Lee; Thandinkosi E. Madiba; Steven D. Wexner; Julio Garcia-Aguilar; Dushyant Sahani; Brendan Moran; Paris Tekkis; Harm J. Rutten; Pieter J. Tanis; Theo Wiggers; Gina Brown

doi:10.1097/SLA.0000000000003251

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

Nigel D'Souza^*, Michael P. M. de Neree Tot Babberich, Andre d'Hoore, Emmanuel Tiret, Evaghelos Xynos, Regina G. H. Beets-Tan, Iris D. Nagtegaal, Lennart Blomqvist, Torbjorn Holm, Bengt Glimelius, Antonio Lacy, Andres Cervantes, Robert Glynne-Jones, Nicholas P. West, Rodrigo O. Perez, Claudio Quadros, Kil Yeon Lee, Thandinkosi E. Madiba, Steven D. Wexner, Julio Garcia-AguilarDushyant Sahani, Brendan Moran, Paris Tekkis, Harm J. Rutten, Pieter J. Tanis, Theo Wiggers, Gina Brown

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

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 rectumis 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.

Original language	English
Pages (from-to)	955-959
Number of pages	5
Journal	Annals of Surgery
Volume	270
Issue number	6
DOIs	https://doi.org/10.1097/SLA.0000000000003251
Publication status	Published - Dec 2019

Keywords

anatomy
MRI
rectum
sigmoid
PREOPERATIVE RADIOTHERAPY
POSTOPERATIVE CHEMORADIOTHERAPY
CANCER
GUIDELINES
MANAGEMENT
RESECTION
COLON

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D'Souza, N., Babberich, M. P. M. D. N. T., d'Hoore, A., Tiret, E., Xynos, E., Beets-Tan, R. G. H., Nagtegaal, I. D., Blomqvist, L., Holm, T., Glimelius, B., Lacy, A., Cervantes, A., Glynne-Jones, R., West, N. P., Perez, R. O., Quadros, C., Lee, K. Y., Madiba, T. E., Wexner, S. D., ... Brown, G. (2019). Definition of the Rectum: An International, Expert-based Delphi Consensus. Annals of Surgery, 270(6), 955-959. https://doi.org/10.1097/SLA.0000000000003251

@article{4be4769a73ee4901a5bb51da98ecaade,

title = "Definition of the Rectum: An International, Expert-based Delphi Consensus",

abstract = "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 rectumis 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.",

keywords = "anatomy, MRI, rectum, sigmoid, PREOPERATIVE RADIOTHERAPY, POSTOPERATIVE CHEMORADIOTHERAPY, CANCER, GUIDELINES, MANAGEMENT, RESECTION, COLON",

author = "Nigel D'Souza and Babberich, {Michael P. M. de Neree Tot} and Andre d'Hoore and Emmanuel Tiret and Evaghelos Xynos and Beets-Tan, {Regina G. H.} and Nagtegaal, {Iris D.} and Lennart Blomqvist and Torbjorn Holm and Bengt Glimelius and Antonio Lacy and Andres Cervantes and Robert Glynne-Jones and West, {Nicholas P.} and Perez, {Rodrigo O.} and Claudio Quadros and Lee, {Kil Yeon} and Madiba, {Thandinkosi E.} and Wexner, {Steven D.} and Julio Garcia-Aguilar and Dushyant Sahani and Brendan Moran and Paris Tekkis and Rutten, {Harm J.} and Tanis, {Pieter J.} and Theo Wiggers and Gina Brown",

note = "Funding Information: Funding: G.B.: National Institute for Health Research (NIHR) Biomedical Research Centre at the Royal Marsden, the Institute of Cancer Research and grant funding from the Pelican Cancer Foundation; N.D{\textquoteright}.S.: As per G.B., and Croydon Colorectal Research Fellowship; N.W.: Yorkshire Cancer Research; A.C.: Grant PI15/02180 to Andr{\'e}s Cervantes from Fondo de Investigaciones Sanitarias (Instituto de Salud Carlos III) from the Spanish Government and CIBERONC; B.G.: Swedish Cancer Society. Publisher Copyright: Copyright {\textcopyright} 2019 Wolters Kluwer Health, Inc. All rights reserved.",

year = "2019",

month = dec,

doi = "10.1097/SLA.0000000000003251",

language = "English",

volume = "270",

pages = "955--959",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "6",

}

D'Souza, N, Babberich, MPMDNT, d'Hoore, A, Tiret, E, Xynos, E, Beets-Tan, RGH, Nagtegaal, ID, Blomqvist, L, Holm, T, Glimelius, B, Lacy, A, Cervantes, A, Glynne-Jones, R, West, NP, Perez, RO, Quadros, C, Lee, KY, Madiba, TE, Wexner, SD, Garcia-Aguilar, J, Sahani, D, Moran, B, Tekkis, P, Rutten, HJ, Tanis, PJ, Wiggers, T & Brown, G 2019, 'Definition of the Rectum: An International, Expert-based Delphi Consensus', Annals of Surgery, vol. 270, no. 6, pp. 955-959. https://doi.org/10.1097/SLA.0000000000003251

TY - JOUR

T1 - Definition of the Rectum

T2 - An International, Expert-based Delphi Consensus

AU - D'Souza, Nigel

AU - Babberich, Michael P. M. de Neree Tot

AU - d'Hoore, Andre

AU - Tiret, Emmanuel

AU - Xynos, Evaghelos

AU - Beets-Tan, Regina G. H.

AU - Nagtegaal, Iris D.

AU - Blomqvist, Lennart

AU - Holm, Torbjorn

AU - Glimelius, Bengt

AU - Lacy, Antonio

AU - Cervantes, Andres

AU - Glynne-Jones, Robert

AU - West, Nicholas P.

AU - Perez, Rodrigo O.

AU - Quadros, Claudio

AU - Lee, Kil Yeon

AU - Madiba, Thandinkosi E.

AU - Wexner, Steven D.

AU - Garcia-Aguilar, Julio

AU - Sahani, Dushyant

AU - Moran, Brendan

AU - Tekkis, Paris

AU - Rutten, Harm J.

AU - Tanis, Pieter J.

AU - Wiggers, Theo

AU - Brown, Gina

N1 - Funding Information: Funding: G.B.: National Institute for Health Research (NIHR) Biomedical Research Centre at the Royal Marsden, the Institute of Cancer Research and grant funding from the Pelican Cancer Foundation; N.D’.S.: As per G.B., and Croydon Colorectal Research Fellowship; N.W.: Yorkshire Cancer Research; A.C.: Grant PI15/02180 to Andrés Cervantes from Fondo de Investigaciones Sanitarias (Instituto de Salud Carlos III) from the Spanish Government and CIBERONC; B.G.: Swedish Cancer Society. Publisher Copyright: Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2019/12

Y1 - 2019/12

N2 - 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 rectumis 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.

AB - 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 rectumis 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.

KW - anatomy

KW - MRI

KW - rectum

KW - sigmoid

KW - PREOPERATIVE RADIOTHERAPY

KW - POSTOPERATIVE CHEMORADIOTHERAPY

KW - CANCER

KW - GUIDELINES

KW - MANAGEMENT

KW - RESECTION

KW - COLON

U2 - 10.1097/SLA.0000000000003251

DO - 10.1097/SLA.0000000000003251

M3 - Article

C2 - 30973385

SN - 0003-4932

VL - 270

SP - 955

EP - 959

JO - Annals of Surgery

JF - Annals of Surgery

IS - 6

ER -