Expert opinionThe multidisciplinary rectal cancer treatment: Main convergences, controversial aspects and investigational areas which support the need for an European Consensus
Section snippets
Material and methods
Five aspects of rectal cancer staging and treatment were analyzed: ‘Staging’, ‘Preoperative Radiotherapy’, ‘Preoperative Radiotherapy, Negative Specimen and Sphincter Preservation’, ‘Postoperative Treatment’ and ‘Therapy of Metastatic Disease’. Each of them represented a section in a questionnaire tailored for this purpose. The questionnaire had 159 questions addressing the main aspects in rectal cancer staging and treatment. The questionnaire was defined by the Board of the Experts involved in
Staging (Appendix III)
Endoanal Ultrasound (EUS) was considered as mandatory in T staging, in the evaluation of sphincter infiltration by the tumour, and in the restaging of T after preoperative long course radiotherapy+concomitant chemotherapy. Magnetic Resonance Imaging (MRI) was considered mandatory in the evaluation of mesorectal fascia infiltration. Endoscopy had a moderate agreement for the definition of tumour location, and the barium enema as optional. Digital rectal examination was considered complementary
Discussion
The process analyzed, the outcomes of staging methodologies and treatment modalities to identify which of them had produced a level of agreement among participants to be used as reference for defining future programmes, investigational protocols and ‘guidelines’, i.e. clinical recommendations. The goal was to identify the main convergences, controversial aspects and investigational areas of each diagnostic and therapeutic approach to offer support to the different strategies that
Conclusion
The process addressed the outcomes in the literature of staging and treatment to identify main convergences, controversial aspects and investigational areas to offer a more detailed understanding on the arguments to debate for the following definition of ‘guidelines’, clinical recommendations and official Consensus.
More than 100 Centres, mostly Italian, participated in the process either as Experts or as physicians who treat a high volume of patients. The original data and composition of the
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