The Fellowship of the European Board of Surgery in Coloproctology (UEMS/ESCP) assesses the full breadth of colorectal surgery. Practise with FEBS Coloproctology questions covering colorectal cancer, total mesorectal excision, inflammatory bowel disease and benign proctology, each answer referenced to ESCP and ESMO guidelines and the trials that shaped them.
Content reviewed 26 August 2026 against current guidelines.
Start practising freeTaken from the bank, not written for this page. Answer it in your head, then open the explanation.
A 62-year-old man presents with fresh rectal bleeding and altered bowel habit for 3 months. Colonoscopy reveals a 3.5 cm pedunculated polyp at 12 cm from the anal verge (Paris 0-Ip, Kudo pit pattern Vn). Hot snare polypectomy is performed. Pathology: T1 adenocarcinoma, sm3 (2,800 µm from muscularis mucosae), moderate differentiation (G2), no lymphovascular invasion (LVI), R0 margins (2 mm). Tumour budding: Bd2 (intermediate). MRI rectum: no residual lesion, no lymph node involvement. Which is the most appropriate next management?
Correct answer: E
T1 colorectal carcinoma risk stratification for lymph node metastasis (LNM) uses the following features: (1) submucosal invasion depth: sm1 (<1,000 µm) LNM ~1–3%; sm2 (1,000–2,000 µm) ~8–9%; sm3 (>2,000 µm, here 2,800 µm) ~15–25%; (2) tumour budding: Bd1 low (0–4 buds/0.785 mm²), Bd2 intermediate (5–9), Bd3 high (≥10) — budding ≥Bd2 independently predicts LNM; (3) LVI: positive = high risk; (4) grade: G3 = high risk; (5) positive/close margins. Per ESMO 2023 and ESCP guidelines: completion surgical resection is recommended when estimated LNM risk exceeds ~5–10%. This patient: sm3 (2,800 µm) = alone ~15–25% LNM risk; Bd2 intermediate budding adds additional LNM risk. The combination (sm3 + Bd2) places the patient clearly in the high-risk category where completion TME is recommended. R0 margins and absent LVI are favourable but do not negate the sm3 and Bd2 burden. For a 12 cm rectal tumour, TME (low anterior resection) is the appropriate completion surgery. Endoscopic re-excision (TEM/TAMIS) addresses local recurrence risk but does NOT provide lymph node clearance — inadequate for sm3 + Bd2. Short-course RT is for more advanced rectal cancer requiring neoadjuvant therapy — not appropriate as the primary modality for T1 high-risk features.
Teaching point. T1 rectal carcinoma sm3 (2,800 µm) + Bd2 tumour budding = high-risk LNM (~15–25%): completion TME recommended. TEM/TAMIS only addresses local recurrence — no nodal clearance for sm3+Bd2. LVI absent and R0 margins are reassuring but insufficient to omit surgery for sm3+Bd2.
Referenced to ESMO Rectal Cancer Guidelines 2023; ESCP/ACPGBI Local Excision Guidelines 2022; NCCN Rectal Cancer v4.2025; ESGE Colorectal T1 Cancer Management Guidelines 2020 (Ferlitsch)
Every question is explained like this — start with 50 free ›Every question is written by Pablo Lozano Lominchar, MD, PhD, and mapped to this board’s published syllabus. Before it enters the bank it has to pass an automated check: five options, a written explanation, and a citation — a named society guideline or a named trial. Benign and functional topics cannot be published without a society guideline; oncological ones cite NCCN, ESMO or AJCC, and the classification systems that govern a topic — Bethesda, TIRADS, Atlanta, Prague, Chicago — have to appear where they apply. The author has audited the full active bank against current guideline versions: what fails is re-cited, rewritten or withdrawn. 650 questions are currently withdrawn and are served to nobody.
Scope of authorship. FEBS Coloproctology sits outside the author’s own subspecialty practice, which is surgical oncology — peritoneal malignancy, sarcoma, hepatopancreatobiliary and complex pelvic surgery. No diplomate of this board has signed these questions off. What they offer is traceability rather than personal authority: every answer names the current guideline or trial it rests on, so you can check it at the source before you trust it. Found an error? Tell us — it gets corrected or withdrawn.
Prioritise total mesorectal excision technique and neoadjuvant sequencing — RAPIDO and PRODIGE 23 appear frequently — and know the ESCP and ESMO colorectal guidelines chapter by chapter. Practise timed questions and rehearse structured case presentations for the oral viva.
SurgBoardsQ&A offers more than 1,600 coloproctology practice questions mapped to the FEBS Coloproctology syllabus, each with a full guideline-referenced explanation.
The FEBS Coloproctology exam is not a multiple-choice test: it combines a case-based written paper (about 1 hour) with two oral components — a clinical case discussion and an academic paper discussion. It is held annually at the ESCP Annual Meeting, and candidates must reach at least 60% in each section and 66% overall.
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