4507 Endoscopic ultrasound accurately stages and directs the surgical management of rectal carcinoma.

Abstract

Background: Endoscopic Ultrasound (EUS) has become one of the best methods for staging gastrointestinal cancers. The preoperative local staging of rectal cancer is important since new transanal surgical techniques can preserve rectal and anal function. The purpose of this study is to assess the accuracy of EUS staging and evaluate the impact of EUS on the surgical management of rectal cancer. Method:A retrospective chart and database review of 23 patients with rectal cancer who underwent rectal EUS at Cornell Weill Medical College from 1997 to 1999 was performed. The medical history, EUS staging, surgical pathology, radiographic studies, and treatment were reviewed. Result: 17 patients had surgical pathology available from 23 patients. Using surgical pathology as the benchmark, accuracy of EUS staging was assessed. T stage accuracy was 94 % (16/17), and N stage accuracy was 100 % (17/17). Fine Needle Aspiration (FNA) was performed on 4 patients and yielded the correct diagnosis with 100% accuracy (4/4). In 6 patients with EUS stage T3N0 or greater (4 patients with EUS stage T3N0 and 2 patients with EUS stage T3N1), 2 patients underwent low anterior resection (LAR) and 3 patients underwent abdominal peritoneal resection (APR). 1 patient underwent transanal resection (TAR) because he was poor surgical candidate. In 11 patients with EUS stage T2 N0 or less (7 patients with EUS stage T2N0 and 4 patients with EUS stage T1N0), 2 patients had endoscopic removal, 5 patients underwent TAR and 4 patients had LAR. 10 of the 11 patients were accurately staged and 1 patient was overstaged as T2 by EUS. No patients were understaged. EUS directed surgical management in 85 % (12/14) of patients with rectal cancer. For these patients, T3 or N1 EUS staging resulted in LAR and EUS T2, T1, and N0 determinations resulted in TAR. Conclusion: EUS can accurately stage rectal cancer and direct the choice of surgical approach. Further study is needed to draw more definitive conclusions.