Techniques in Coloproctology

, Volume 23, Issue 8, pp 743–749 | Cite as

Surgical techniques in the management of rectal cancer: a modified Delphi method by colorectal surgeons in Australia and New Zealand

  • S. W. BellEmail author
  • A. G. Heriot
  • S. K. Warrier
  • C. K. Farmer
  • A. R. L. Stevenson
  • I. Bissett
  • J. C. Kong
  • M. Solomon
Original Article



Technological developments have allowed advances in minimally invasive techniques for total mesorectal excision such as laparoscopy, robotics, and transanal surgery. There remains an ongoing debate about the safety, benefits, and appropriate clinical scenarios for which each technique is employed. The aim of this study was to provide a panel of expert opinion on the role of each surgical technique currently available in the management of rectal cancer using a modified Delphi method.


Surveys were designed to explore the key patient- and tumor-related factors including clinical scenarios for determining a surgeon’s choice of surgical technique.


Open surgery was favoured in obese patients with an extra-peritoneal tumor and a positive circumferential resection margin (CRM) or T4 tumor when a restorative resection was planned. Laparoscopy was favoured in non-obese males and females, in both intra- and extra-peritoneal tumors with a clear CRM. Robotic surgery was most commonly offered to obese patients when the CRM was clear and if an abdominoperineal resection was planned. Transanal total mesorectal excision (taTME) was preferred in male patients with a mid or low rectal cancer, particularly when obese. Transanal endoscopic microsurgery/transanal minimally invasive surgery local excision was only offered to frail patients with small, early stage tumors.


All surgical techniques for rectal cancer dissection have a role and may be considered appropriate. Some techniques have advantages over others in certain clinical situations, and the best outcomes may be achieved by considering all options before applying an individualised approach to each clinical situation.


Delphi technique Rectal neoplasms Procedures and techniques’ utilization Clinical decision-making 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was obtained for the study.

Informed consent

Informed consent was obtained from all individual participants involved in completing the study.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • S. W. Bell
    • 1
    • 2
    Email author
  • A. G. Heriot
    • 3
    • 4
  • S. K. Warrier
    • 1
    • 2
    • 3
  • C. K. Farmer
    • 1
    • 2
  • A. R. L. Stevenson
    • 5
    • 6
  • I. Bissett
    • 7
  • J. C. Kong
    • 3
    • 4
  • M. Solomon
    • 8
  1. 1.Department of Colorectal SurgeryMonash UniversityMelbourneAustralia
  2. 2.Alfred HospitalMonash UniversityMelbourneAustralia
  3. 3.Division of Cancer ResearchUniversity of MelbourneMelbourneAustralia
  4. 4.Peter MacCallum Cancer CentreUniversity of MelbourneMelbourneAustralia
  5. 5.Faculty of Medicine and Biomedical SciencesUniversity of QueenslandBrisbaneAustralia
  6. 6.Royal Brisbane and Women’s HospitalBrisbaneAustralia
  7. 7.Department of SurgeryUniversity of AucklandAucklandNew Zealand
  8. 8.Institute of Academic Surgery, Royal Prince Alfred HospitalUniversity of SydneySydneyAustralia

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