International trends in surgical treatment of rectal cancer

Background Surgical technique might influence rectal cancer survival, yet international practices for surgical treatment of rectal cancer are poorly described. Methods We performed a cross-sectional survey in a cohort of experienced colorectal surgeons representing 123 centers. Results Seventy-one percent responded, 70% are from departments performing more than 50 proctectomies annually. More than 50% defined the rectum as "15 cm from the verge." Seventy-two percent perform laparoscopic proctectomy, 80% use oral bowel preparation, 69% perform high ligation of the inferior mesenteric artery, 76% divert stomas as routine for colo-anal anastomosis, and 63% use enhanced recovery protocols. Different practices exist between US and non-US surgeons: 15 cm from the verge to define the rectum (34% vs 59%; P = .03), personally perform laparoscopic resection (82% vs 66%; P = .05), rectal stump washout (36% vs 73%; P = .0001), always drain after surgery (23% vs 42%; P = .03), transanal endoscopic microsurgery for T2N0 in medically unfit patients (39% vs 61%; P = .0001). Conclusions Wide international variations in rectal cancer management make outcome comparisons challenging, and consensus development should be encouraged.