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Preoperative adjuvant radiation combined with chemotherapy is a recent development in the management of patients with rectal cancer invading perirectal tissue and regional lymph nodes. This study was performed to assess the impact of preoperative adjuvant therapy in patients judged by endorectal ultrasound to have extramural invasion of rectal cancer and/or regional lymph node involvement on tumor regression in bowel wall T and lymph nodes N. The predictive value of ultrasound in staging wall penetration and lymph node involvement after preoperative adjuvant therapy was also assessed.Fifty-one patients were selected by ultrasound to have preoperative irradiation (40-50 Gy over 5-6 weeks). In 29 patients this was combined with 5-fluorouracil chemotherapy. Assessments of ultrasound were compared with pathologic findings in the resected specimen in all patients.Partial downstaging was seen in 37 (72.5%) patients with wall invasion T and in five (9.8%) of 51 patients with lymph node involvement N. Complete downstaging was achieved in one (2.0%) patient with wall invasion T and in 20 (39.2%) of 51 patients with lymph node involvement N. Positive predictive values of ultrasound after irradiation were 47 (92.2%) and 45 (82.2%) for wall penetration and lymph node status, respectively. Negative predictive values of ultrasound after irradiation were rare 3.9% and 5.9%, respectively.In the majority of patients with rectal cancer invading perirectal tissues or lymph nodes, lesions downstages by preoperative chemo radiotherapy. Endorectal ultrasound examination before and after chemo radiotherapy for rectal cancer is one of the most recommended in staging rectal cancer.

The aim of the present study was to compare the accuracy of transrectal ultrasound in staging rectal carcinoma. 30 consecutive patients with rectal carcinoma proven pathomorphological were staged transrectal ultrasound and computed tomography imaging, and then underwent radical surgery. The data of preoperative staging were compared with pathomorphological findings of the specimens according to Surgical excised the TNM classification system. Transrectal ultrasound showed better results than computed tomography in evaluating N (sensitivity 45.2%, specificity 45.2%), because the parameters of sensitivity and specificity were high enough (76.6%). Computed tomography has limited usefulness in staging rectal tumors because the layers of the rectal wall are not resolved by computed tomography. In T staging transrectal ultrasound sensitivity and specificity ranges 87.54% and 94.82% respectively and that enables to perform adequate surgical procedure.