Endoscopy 2011; 43 - A45
DOI: 10.1055/s-0031-1292116

Role of transrectal ultrasound in the recurrence of rectal cancer

A Isern 1, C Fernández 1, K Hernandez 2, M Bronstein 2, J Salazar 2, S Fernandez 3
  • 1Associate Gastroenterologists of the Gastroenterology and Ultrasound Units of the Servicio Oncológico Hospitalario del IVSS. Caracas, Venezuela
  • 2Associate Gastroenterologists of the Gastroenterology Unit of the Servicio Oncológico Hospitalario del IVSS. Caracas, Venezuela
  • 3Associate Gastroenterologists of the Gastroenterology Unit of the Hospital Universitario de. Caracas, Venezuela

Transrectal ultrasonography (TRUS) has an important role in the evaluation of rectal tumors. It is used to determine the depth of tumor spread into the rectal wall, the extent of tissue invasion to neighboring organs, and also to explore the peri-rectal environment and detect possible metastatic nodes. TRUS has proven to be a very accurate imaging technique in the preoperative staging of rectal tumors, contributing to improve therapeutic management and prognosis. Recurrence rates after surgery are approximately 3 to 35% (depending on the preoperative staging), decreasing after radiation to 10%. The recurrence risk is greatest in the first 18 to 24 months after surgery. TRUS guided biopsy at the anastomotic or perianastomotic tissue allows differentiation between malignant and benign lesions. We suggest that TRUS can therefore be used to detect early local recurrence and/or benign post operative complications at the site of anastomosis.

From a pool of 320 patients with confirmed rectal cancer who had undergone a sphincter- preserving operation, evaluated from March 1991 to October 2008, long term follow-up was available for 71 patients. Of these, 63 completed the follow-up TRUS procedure (TRUS performed every 3 months for the first year and every 6 months the second and third year of surveillance) and, 8 never completed the follow-up but had TRUS performed after symptoms of recurrence appeared (12–20 months after surgery).

Abnormalities in the peri-anastomotic tissues were found in 24 of 63 patients followed by TRUS: Cancer recurrence was solely found by the ultrasound probe in 19 patients. Benign changes due to radiation (fibrosis) were present in 4 patients and, 1 patient had a granuloma. All these confirmed by biopsy. Analysis through a nonparametric test (x2 distribution) shows a significant statistical difference (p<0.05) demonstrating recurrence is more likely to be detected with TRUS compared with endoscopy.

Conclusions: These results suggest that TRUS should be an accurate method to detect local recurrence cancer at early surveillance and TRUS guided biopsy is a safe and efficient method for tissue sampling of rectal and perirrectal lesions.