The investigation of primary rectal cancer by surgeons: current pattern of practice

Abstract

Objective: Selection of the optimal treatment strategy for patients with rectal cancer requires appropriate investigation, but published guidelines provide no clear consensus. We examined the current practice pattern for the investigation of primary rectal cancer by general surgeons in the province of Ontario, Canada.

Methods: A telephone interview was completed by 124 surgeons in Ontario who manage patients with rectal cancer, who indicated the investigations they routinely perform in assessment before treatment. An exploratory cluster analysis was used to identify surgeon-related variables that predicted the pattern of investigation; these were tested in univariate and multivariate analyses.

Results: Cluster analysis identified 3 distinct groups of surgeons based on patterns of test usage. Univariate analysis showed that the use of chest radiography, computed tomography of the abdomen and pelvis, and ultrasound of the abdomen varied significantly with the surgeon's subspecialty training, practice location and years in practice. Regression analysis confirmed that each of these 3 variables independently predicted the pattern of preoperative investigation. There were no significant predictors of the use of colonoscopy, sigmoidoscopy or carcinoembryonic antigen level. Over half of surgeons reported that they would have ordered additional imaging tests but did not because of lack of availability. The perceived desirability of additional tests, endorectal ultrasound in particular, varied with training.

Conclusions: The current practice pattern for the preoperative investigation of primary rectal cancer by general surgeons varies significantly with specific surgeon-related variables, with potential impact on the management and outcome of patients with rectal cancer.

FIG. 1. Distribution of the 124 surgeons surveyed, according to their years in practice and number of operations for rectal cancer performed per year.

FIG. 2. Proximal and distal boundaries of the rectum as defined by all respondents who completed the survey ( n = 124). The percentage of surgeons naming a particular proximal or distal boundary is indicated. (For the distal boundary, 1 surgeon did not respond.)

FIG. 3. Proportion of the 124 respondents who reported routinely ordering the indicated test in the preoperative investigation of rectal cancer. Abdom = abdominal; CEA = carcinoembryonic antigen.