Current Practices in Rectal Cancer Surgery: A Survey of Thai Colorectal Surgeons
Varut Lohsiriwat MD*, Darin Lohsiriwat MD*, Parinya Thavichaigarn MD**
Affiliation : * Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Surgery, Pramongkutklao Hospital, Bangkok, Thailand
Objective : Surgical techniques and management of rectal cancer have been rapidly evolving. The aim of the
present study was to assess current practices in rectal cancer surgery among Thai colorectal surgeons.
Material and Method: Descriptive study was set between July and September 2008, a questionnaire was
distributed to members (board-certified colorectal surgeons) of the Society of Colon and Rectal Surgeons
Thailand regarding their current practices in rectal cancer including pre-operative management, surgical
techniques, and postoperative surveillance protocol. Their perception of laparoscopic surgery was also
emphasized.
Results : Forty questionnaires were returned (80% response rate). Of the respondents, 45% worked in a
university hospital. Surgeons were in broad agreement (>75 percent agree) on the routine preoperative use
of carcinoembryonic antigen, CT or MRI of the pelvis for cancer staging, mechanical bowel preparation,
pelvic drainage after colorectal anastomosis, and postoperative surveillance in patients with curative resection.
Opinion was divided (<75 percent agreement) on the use of neoadjuvant therapy for locally advanced rectal
cancer, lateral pelvic node dissection, rectal irrigation prior to bowel resection, air-testing after bowel
anastomosis, the need of protective stoma, and duration of prophylactic antibiotics. Thirty-three surgeons
(82.5%) believed that laparoscopic surgery achieved the same oncological outcomes of open surgery;
however, only 40% of surgeons have experience in laparoscopic resection for rectal cancer.
Conclusion : There is a considerable diversity of clinical practice for rectal cancer surgery, particularly in
preoperative chemoradiation in locally advanced rectal cancer and to perform protective stoma after colorectal
anastomosis. Meanwhile, postoperative surveillance protocol is quite uniform, and laparoscopic rectal
surgery has gained attention among Thai colorectal surgeons.
Keywords : Rectal cancer, Survey, Surgery, Surveillance, Stoma, Drainage, Laparoscopic
