Assessment of clinical impact of endoscopic ultrasound on rectal cancer

INTRODUCTION: Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) is the most accurate imaging modality for locoregional staging of rectal cancer. It remains unclear whether this technology impacts the clinical outcome of patients with this malignancy. The aim of this study was to assess the impact of EUS FNA by comparing the clinical outcomes of patients with rectal cancer before and after the introduction of EUS in our institution. METHODS: Outcomes of patients with de novo nonmetastatic rectal cancer seen in 1999 without EUS evaluation (non-EUS control group) were compared to patients evaluated in 2000/2001 with EUS FNA (EUS group). RESULTS: Outcomes of 68 (non-EUS control group) and 73 (EUS group) patients with nonmetastatic rectal cancer were compared. Among patients with advanced T or N stage, adjuvant therapy was administered to 45 patients (84.9%; preoperative to 31 (58.5%) patients and postoperative to 14 (26.4%)) in the EUS group; adjuvant therapy was administered to 37 patients (78.7%; preoperative to 7 (14.9%) patients and postoperative to 30 (63.8%)) in the non-EUS group. Cox proportional hazards demonstrated EUS FNA to be associated with reduced tumor recurrence risk, hazard ratio, 0.72 (95% Cl: 0.52-0.97, p = 0.03). CONCLUSIONS: EUS staging of rectal cancer appears to facilitate appropriate employment of preoperative neoadjuvant therapy in those patients with advanced disease. EUS use is associated with a recurrence-free survival advantage in patients, supporting its routine use in rectal cancer staging.