Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 25, 2015; 7(7): 688-701
Published online Jun 25, 2015. doi: 10.4253/wjge.v7.i7.688
Role of endoscopic ultrasonography in the loco-regional staging of patients with rectal cancer
Pietro Marone, Mario de Bellis, Valentina D’Angelo, Paolo Delrio, Valentina Passananti, Elena Di Girolamo, Giovanni Battista Rossi, Daniela Rega, Maura Claire Tracey, Alfonso Mario Tempesta
Pietro Marone, Mario de Bellis, Valentina D’Angelo, Elena Di Girolamo, Giovanni Battista Rossi, Alfonso Mario Tempesta, Endoscopy Unit, Istituto Nazionale Tumori - IRCCS, 80131 Naples, Italy
Paolo Delrio, Daniela Rega, Division of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS, 80131 Naples, Italy
Valentina Passananti, Division of Gastroenterology Medical School, University Federico II, 80131 Naples, Italy
Maura Claire Tracey, Division of Thoracic Surgery Istituto Nazionale Tumori-IRCCS, 80131 Naples, Italy
Author contributions: Marone P, D’Angelo V and Passananti V contributed to revision of the literature and selection of relevant articles; Marone P, de Bellis M and D’Angelo V contributed to composition of the manuscript; de Bellis M, Delrio P, Di Girolamo E, Rossi GB, Rega D and Tempesta AM contributed to critical revision of the manuscript; Tracey MC contributed to English revision.
Conflict-of-interest: The authors declare that there are no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Pietro Marone, MD, Endoscopy Unit, Istituto Nazionale Tumori-IRCCS, Fondazione G Pascale, Via Mariano Semmola snc, 80131 Naples, Italy. p.marone@istitutotumori.na.it
Telephone: +39-081-5903228 Fax: +39-081-5903824
Received: October 5, 2014
Peer-review started: October 6, 2014
First decision: October 28, 2014
Revised: February 7, 2015
Accepted: March 18, 2015
Article in press: March 20, 2015
Published online: June 25, 2015
Abstract

The prognosis of rectal cancer (RC) is strictly related to both T and N stage of the disease at the time of diagnosis. RC staging is crucial for choosing the best multimodal therapy: patients with high risk locally advanced RC (LARC) undergo surgery after neoadjuvant chemotherapy and radiotherapy (NAT); those with low risk LARC are operated on after a preoperative short-course radiation therapy; finally, surgery alone is recommended only for early RC. Several imaging methods are used for staging patients with RC: computerized tomography, magnetic resonance imaging, positron emission tomography, and endoscopic ultrasound (EUS). EUS is highly accurate for the loco-regional staging of RC, since it is capable to evaluate precisely the mural infiltration of the tumor (T), especially in early RC. On the other hand, EUS is less accurate in restaging RC after NAT and before surgery. Finally, EUS is indicated for follow-up of patients operated on for RC, where there is a need for the surveillance of the anastomosis. The aim of this review is to highlight the impact of EUS on the management of patients with RC, evaluating its role in both preoperative staging and follow-up of patients after surgery.

Keywords: Rectal cancer, Staging, Endoscopic ultrasonography, Accuracy, Therapeutic strategy

Core tip: In the era of tailored management of patients with rectal cancer (RC), endoscopic ultrasonography (EUS) has become crucial for the appropriate preoperative staging of these patients. This review highlights the impact of EUS on the management of patients with RC, evaluating its role in both preoperative staging of RC and follow-up of patients after surgery. Finally, possible new application are discussed, on the basis of the technologic innovation and the evolution of the therapeutic strategies.