Dis Colon Rectum. 2024 May 3. doi: 10.1097/DCR.0000000000003301. Online ahead of print.
ABSTRACT
BACKGROUND: Some guidelines for rectal carcinoma consider 12 cm, measured by rigid endoscopy to be the cutoff tumor height for optional neoadjuvant chemoradiation. Measuring differences of only a few centimeters may therefore predetermine choice of further therapy. However, rigid endoscopy may exhibit similar operator dependence as do most other clinical examination methods.
OBJECTIVES: Evaluation of concordance of rigid rectoscopic tumor height measurements performed by 4 experienced examiners, 2 in lithotomy and 2 in left lateral position. Assessment of tumor palpability and distance of the anal verge to the anocutaneous line were also evaluated.
DESIGN: Prospective observational study.
SETTING: Academic teaching hospital, referral center for colorectal surgery.
PATIENTS: There were 50 patients, of whom were 35 males (70%). The median age was 72.5 years (53-88 years).
MAIN OUTCOME MEASURES: Interrater agreement of tumor height assessment and tumor allocation beneath or beyond the 12-cm height limit.
RESULTS: With an intraclass correlation coefficient of 0.947 (95% CI: 0.918-0.967, p < 0.001), interrater reliability of tumor height assessment was statistically rated “excellent.” Despite this, in 26% of patients, there was no agreement regarding the allocation of the tumor beneath or beyond the 12-cm height limit. Furthermore there was also considerable disagreement concerning tumor palpability and the distance of the anal verge to the anocutaneous line. Patient positioning was not found to influence results.
LIMITATIONS: Single center study.
CONCLUSIONS: Rigid rectal endoscopy may not be a sound pivotal basis for the consideration of optional chemoradiation in rectal carcinoma. Application of a universally valid height limit obviously ignores biological variability in body frame, gender, and acquired pelvic descent. Eligibility for neoadjuvant therapy should not rely on height measurements alone. Uniform MRI or CT imaging protocols, based on agreed terminology, including factors such as tumor height relative to pelvic frame and peritoneal reflection, may be an important diagnostic addition for such decision. See Video Abstract.
CLINICAL TRIAL REGISTRATION: DRKS00012758 (German National Study Registry), ST-D 406 (German Cancer Society).
PMID:38701433 | DOI:10.1097/DCR.0000000000003301
