J Med Assoc Thai Vol. 92 No. 8 2009 1009 J Med Assoc Thai 2009; 92 (8): 1009-15 Full text. e-Journal: http://www.mat.or.th/journal During the last few decades, several surgical techniques and management of rectal cancer have been rapidly evolving. For instance, complete removal of the mesorectum, known as total mesorectal excision which was introduced by Heald in 1982, has now become a gold standard treatment of middle and lower rectal cancer as it reduces a local recurrence of the tumor (1) . Imaging devices, such as helical computed tomographic (CT) scan or magnetic resonance image (MRI), play an important role in preoperative tumor staging and postoperative surveillance. Meanwhile, preoperative chemoradiation has been selectively used in the cases of locally advanced rectal cancer in order to minimize positive circumferential resection margin and to reduce local recurrence rate (2) . Recently, laparoscopic surgery in various gastrointestinal diseases including rectal cancer is increasingly popular because it could provide less pain, shorter hospital stay, faster postoperative recovery, and better cosmetic appearance compared to open surgery (3) . Laparoscopic surgery for rectal cancer is yet a complicated operation requiring highly skilled Current Practices in Rectal Cancer Surgery: A Survey of Thai Colorectal Surgeons Varut Lohsiriwat MD*, Darin Lohsiriwat MD*, Parinya Thavichaigarn MD** * Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Surgery, Pramongkutklao Hospital, Bangkok, Thailand Objective: Surgical techniques and management of rectal cancer have been rapidly evolving. The aim of the present study was to assess current practices in rectal cancer surgery among Thai colorectal surgeons. Material and Method: Descriptive study was set between July and September 2008, a questionnaire was distributed to members (board-certified colorectal surgeons) of the Society of Colon and Rectal Surgeons Thailand regarding their current practices in rectal cancer including pre-operative management, surgical techniques, and postoperative surveillance protocol. Their perception of laparoscopic surgery was also emphasized. Results: Forty questionnaires were returned (80% response rate). Of the respondents, 45% worked in a university hospital. Surgeons were in broad agreement (>75 percent agree) on the routine preoperative use of carcinoembryonic antigen, CT or MRI of the pelvis for cancer staging, mechanical bowel preparation, pelvic drainage after colorectal anastomosis, and postoperative surveillance in patients with curative resection. Opinion was divided (<75 percent agreement) on the use of neoadjuvant therapy for locally advanced rectal cancer, lateral pelvic node dissection, rectal irrigation prior to bowel resection, air-testing after bowel anastomosis, the need of protective stoma, and duration of prophylactic antibiotics. Thirty-three surgeons (82.5%) believed that laparoscopic surgery achieved the same oncological outcomes of open surgery; however, only 40% of surgeons have experience in laparoscopic resection for rectal cancer. Conclusion: There is a considerable diversity of clinical practice for rectal cancer surgery, particularly in preoperative chemoradiation in locally advanced rectal cancer and to perform protective stoma after colorectal anastomosis. Meanwhile, postoperative surveillance protocol is quite uniform, and laparoscopic rectal surgery has gained attention among Thai colorectal surgeons. Keywords: Rectal cancer, Survey, Surgery, Surveillance, Stoma, Drainage, Laparoscopic Correspondence to: Lohsiriwat V, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. Phone: 0-2419-8077, Fax: 0-2411-5009, E-mail: bolloon@hotmail.com