Rectal cancer surgery: radiology roadmaps

Key points Based on radiological imaging, a 'radiology roadmap' succinctly describes how rectal cancer could be potentially resected with a high probability of histologically clear (R0) margins Radiology roadmaps are increasingly provided as part of a radiology report by specialist gastrointestinal radiologists Radiology roadmaps are created after review of all relevant scans, particularly high-resolution pelvic MRI examinations showing the cancer at its maximal extent, the 'high-tide mark', in terms of volume and/or boundary (often before neoadjuvant treatment) Radiology roadmaps can be modified by the surgeon after consideration of clinical and patient-related factors to create a final 'surgical roadmap' used to guide the operation in theatre Radiology roadmaps for cancers requiring extended resection are refined in close collaboration with the surgical team, ideally in a dedicated multidisciplinary team and using multimedia aids, such as video vignettes Colorectal surgical trainees should be familiar with the benefits and limitations of imaging; they should be cognisant of the experience of the reporting radiologist when assimilating the information from radiology roadmaps