Evolution of surgical approach to rectal cancer resection: A multinational registry assessment

Julie M.L. Sijmons*, Jan Willem T. Dekker, Jurriaan B. Tuynman, International Colorectal Cancer Registry Collaboration (ICORC) Collaborators, Helen M. Mohan, Philip Smart, Alexander G. Heriot, Kate Walker, Angela Kuryba, Peter Matthiessen, Pieter J. Tanis, Tarik Sammour, Hidde Kroon, Sze Lin Peng, Neal Rawson, Shoni Philpot, Ian Hayes, Lene Hjerrild Iversen, Danish Colorectal, Jon Kroll BjerregaardCamilla Qvortrup, Ismail Gogenur, Richard Spence, Rob Tollenaar, Roel Hompes, Federico Ghignone, Helen Blake, Nicola Fearnhead, Jan van der Meulen, Mike Braun, Arne Wibe, Janet Graham, Graham Mackay, David Morrison, Ingvar Syk, Clifford Ko, Nicolas Avellaneda

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review



Surgical approach to rectal cancer has evolved in recent decades, with introduction of minimally invasive surgery (MIS) techniques and local excision. Since implementation might differ internationally, this study is aimed at evaluating trends in surgical approach to rectal cancer across different countries over the last 10 years and to gain insight into patient, tumour and treatment characteristics. 


Pseudo-anonymised data of patients undergoing resection for rectal cancer between 2010 and 2019 were extracted from clinical audits in the Netherlands (NL), Sweden (SE), England-Wales (EW) and Australia-New Zealand (AZ). 


Ninety-nine thousand five hundred ninety-seven patients were included (38,413 open, 55,155 MIS and 5416 local excision). An overall increase in MIS was observed from 29.9% in 2010 to 72.1% in 2019, with decreasing conversion rates (17.5–9.0%). The MIS proportion was highly variable between countries in the period 2010–2014 (54.4% NL, 45.3% EW, 39.8% AZ, 14.1% SE, P < 0.001), but variation reduced over time (2015–2019 78.8% NL, 66.3% EW, 64.3% AZ, 53.2% SE, P < 0.001). The proportion of local excision for the two periods was highly variable between countries: 4.7% and 11.8% in NL, 3.9% and 7.4% in EW, 4.7% and 4.6% in AZ, 6.0% and 2.9% in SE. 


Application and speed of implementation of MIS were highly variable between countries, but each registry demonstrated a significant increase over time. Local excision revealed inconsistent trends over time.

Original languageEnglish
Article number15
JournalInternational Journal of Colorectal Disease
Issue number1
Publication statusPublished - 6 Jan 2024

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© 2024, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.


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