The selection process can improve the outcome in locally advanced and recurrent colorectal cancer: activity and results of a dedicated multidisciplinary colorectal cancer centre.
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Date
2017-04Author
Kontovounisios, C
Tan, E
Pawa, N
Brown, G
Tait, D
Cunningham, D
Rasheed, S
Tekkis, P
Type
Journal Article
Metadata
Show full item recordAbstract
Aim There is wide disparity in the care of patients with multivisceral involvement of rectal cancer. The results are presented of treatment of advanced and recurrent colorectal cancer from a centre where a dedicated multidisciplinary team (MDT) is central to the management.Method All consecutive MDT referrals between 2010 and 2014 were examined. Analysis was undertaken of the referral pathway, site, selection process, management decision, R0 resection rate, mortality/morbidity/Clavien-Dindo (CD) classification of morbidity, length of stay (LOS) and improvement of quality of life.Results There were 954 referrals. These included locally advanced primary rectal cancer (LAPRC b-TME) (39.0%), rectal recurrence (RR) (22.0%), locally advanced primary colon cancer (LAPCC T3c/d-T4) (21.1%), colon cancer recurrence (CR) (12.4%), locally advanced primary anal cancer (LAPAC-failure of CRT/T3c/d-T4) (3.0%) and anal cancer recurrence (AR) (2.2%). Among these patients 271 operations were performed, 212 primary and 59 for recurrence. These included 16 sacrectomies, 134 total pelvic exenterations and 121 other multi-visceral exenterative procedures. An R0 resection (no microscopic margin involvement) was achieved in 94.4% and R1 (microscopic margin involvement) in 5.1%. In LAPRC b-TME the R0 rate was 96.1% and for RR it was 79%. The LOS varied from 13.3 to 19.9 days. RR operations had the highest morbidity (CD 1-2, 33.3%) and LAPRC operations had the highest rate of CD 3-4 complications (18.4%). Most (39.6%) of the referred patients were from other UK hospitals.Conclusion Advanced colorectal cancer can be successfully treated in a dedicated referral centre, achieving R0 resection in over 90% with low morbidity and mortality. Implementation of a standardized referral pathway is encouraged.
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Subject
Humans
Colorectal Neoplasms
Neoplasm Recurrence, Local
Treatment Outcome
Colectomy
Pelvic Exenteration
Patient Selection
Quality of Life
Referral and Consultation
Patient Care Team
United Kingdom
Research team
Medicine (RMH Smith Cunningham)
Language
eng
Date accepted
2016-06-23
License start date
2017-04
Citation
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2017, 19 (4), pp. 331 - 338