Association of Coloproctology of Great Britain &amp; Ireland (<scp>ACPGBI</scp>): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) – Multidisciplinary Management

Abstract

A definition of rectal cancer is important for optimal planning of neoadjuvant therapy and surgical strategy. Anatomically the rectum is distal to the sigmoid colon and its upper limit is the termination of the sigmoid mesocolon. A commonly used definition is an adenocarcinoma with a distal margin at or below 15 cm from the anal verge, measured by rigid sigmoidoscopy. Standard anatomical texts put this at the level of the third sacral vertebra (Williams & Warwick, 1980) but it is generally agreed by surgeons that the rectum starts at the sacral promontory (UKCCCR, 1989). Whilst there remains debate about the proximal limit of the rectum, there is increasing recognition of the complexity of management of low rectal cancers. The Low Rectal Cancer Development Program (LOREC) has defined a ‘low’ rectal cancer as an MRI-based anatomical definition of an adenocarcinoma with its lower edge, at or below the origin of the levators at the pelvic side-wall. This usually corresponds to a measurement of within 6 cm of the anal verge (PELICAN Cancer Foundation; Salerno et al., 2006a, 2006b). A low rectal cancer should be defined as an MRI-based anatomical definition of an adenocarcinoma with its lower edge, at or below the origin of the levators at the pelvic side-wall. This usually corresponds to a measurement of within 6 cm of the anal verge. 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