Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes (original) (raw)
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Total mesorectal excision for rectal cancer - what can be achieved by a national audit
Colorectal Disease, 2003
Objective The results of rectal cancer surgery in Norway have been poor. In a national audit for the period 1986-88, 28% of the patients developed local recurrence (LR) following treatment with a curative intent. Five-year overall survival was 55% for patients younger than 75 years. The aim of this study is to report how an initiative focusing on better surgery can improve the prognosis for rectal cancer patients on a national level.
Acta chirurgica iugoslavica, 2010
PURPOSE: Although surgery remains the most important treatment of rectal cancer, the management of this disease has evolved to become more multidisciplinary to offer the best clinical outcome. The International Conference on Multidisciplinary Rectal Cancer Treatment: Looking for an European Consensus' (EURECA-CC2) had the due to identify the degree of consensus that could be achieved across a wide range of topics relating to the management of rectal cancer helping shape future programs, investigational protocols and guidelines for staging and treatment throughout Europe. MATERIALS AND METHODS: Consensus was achieved using the Delphi method. Eight chapters were identified: epidemiology, diagnostics, pathology, surgery, radiotherapy and chemotherapy, treatment toxicity and quality of life, follow-up, and research questions. Each chapter was subdivided by topic, and a series of statements were developed. Each committee member commented and voted, sentence by sentence three times. Sentences which did not reach agreement after voting round # 2 were openly debated during the Conference in Perugia (Italy) December 2008. The Executive Committee scored percentage consensus based on three categories: "large consensus", "moderate consensus", "minimum consensus". RESULTS: The total number of the voted sentences was 207. Of the 207, 86% achieved large consensus, 13% achieved moderate consensus, and only 3 (1%) resulted in minimum consensus. No statement was disagreed by more than 50% of members. All chapters were voted on by at least 75% of the members, and the majority was voted on by 85%. CONCLUSIONS: This Consensus Conference represents an expertise opinion process that may help shape future programs, investigational protocols, and guidelines for staging and treatment of rectal cancer throughout Europe. In spite of substantial progress, many research challenges remain.
The multidisciplinary management of rectal cancer
Nature Reviews Gastroenterology & Hepatology, 2020
As rectal cancer treatment becomes more precise, high-resolution imaging techniques have been established to identify important tumour characteristics that help guide management. High-resolution magnetic resonance imaging scans are increasingly dictating treatment strategies by providing predictive and prognostic information related to the tumour, and are a standard part of the patient investigation pathway. Surgical management depends on patient and tumour factors with an aim to optimise function and survival with the lowest risk of recurrence. Multiple approaches are currently available for resection, including radical surgery involving excision of the rectum and associated mesentery and organsparing techniques involving local excision of the lesion or deferring surgery altogether. The pathological assessment of the resected rectal cancer specimen provides a level of quality control ensuring that surgical principles have been adhered to and that the surgery was performed in an optimal oncological manner. Multidisciplinary team presentation of imaging data, evidence-based oncological, surgical and functional recommendations, in addition to pathological assessment of surgical quality, is an essential part of formalised cancer care.
Multidisciplinary Management of Rectal Cancer - a Retrospective Study
2006
MULTIDISCIPLINARY MANAGEMENT OF RECTAL CANCER - A R ETROSPECTIVE STUDY - (Abstract): Background: The procedure of low or very low anterior resection of the rectum with total mesorectal excision (TME) it is now widely accepted for tumours of the middle and lower third of the r ectum. It has become the gold standard for the treatment of c ancer of the rectum, except where the tumor is clos e to or is involving the anal sphincter complex. Patients and methods: A retrospective study on 120 patients diagnosed with colorectal cancer and operated on between 2000 and 2004 was carried out. There were 120 anterior resection of the rectum, in 34 cases the total meso rectal excision has been performed and in 11 cases a very low anterior resection was made. All 45 cases where tot al mesorectal excision was made, had undertaken preoperative radiotherapy, surgery being performed after 4 to 6 weeks from the last session of radioth erapy. Results : The overall operative morbidity rate was 16.10% i n...
Optimizing Rectal Cancer Management
Diseases of the Colon & Rectum, 2014
C olorectal carcinoma remains the second leading cause of cancer-related deaths in Western countries, with rectal carcinoma accounting for ≈25% of cases arising from the large bowel. Rectal cancer affects more than 40,000 patients annually in the united states, and a majority of these patients undergo surgery, with approximately half dying as a consequence of their disease. 1-3 therefore, rectal cancer represents a significant healthcare problem in terms of incidence, seriousness, and use of resources. historically a huge variation among surgeons has been described in results of colorectal cancer surgery, with statistically significant differences in curative resection, postoperative morbidity and mortality, and long-term survival. 4 Rectal cancer surgery is considered more technically challenging compared with colon cancer surgery, mainly because of the anatomy of the pelvis and the resulting challenge that a surgeon faces in achieving good resection margins in a confined, fixed bony space in close proximity to vital structures. historically these challenges have been reflected in poorer oncologic results, with local recurrence rates approaching 30% and worse overall survival in comparison with that of colon cancer. 5 in the united states, the majority of rectal cancer surgeries have traditionally been performed by trained general surgeons, who may or may not have a colorectal subspecialty interest. studies indicate that there is significant room for improvement in the outcomes of rectal cancer surgery, with significant variation in results including rates of margin positivity, local recurrence, use of neoadjuvant and adjuvant therapy, and permanent stomas. some reports indicate variations in local recurrence rates of between 0% and 13% for colorectal surgeons and between 21% and 37% for general surgeons. 6-8 Differences in mortality also exist, with rates of 1.4% for colorectal surgeons and >7.0% for general surgeons being reported. 8 in a recent study of proctectomies, restorative techniques were used in 50% of patients, with abdominoperineal resection rates as high as 60% in some regions. 8,9 in addition, approximately one fifth of proctectomies were performed by a specialist colorectal surgeon, and ≈40% of the surgeons only performed nonrestorative surgery. 10,11 the management of rectal cancer has fundamentally changed in the last 3 decades with the introduction of staging, total mesorectal excision (tme), chemoradiotherapy (CRt), and multidisciplinary management. since the 1980s, 5 main principles have been developed that, when combined, have led to significant reductions in rates of local recurrence, increases in disease-free and overall survival, and reduction in permanent stoma rates. in countries and centers that have implemented such programs, the cancer-specific outcomes from rectal cancer now match those of colon cancer for the first time. 12 the principles include the following: 1) rectal surgery according to the principles of tme, 2) measurement of quality of surgery and accurate staging by specific techniques of pathology assessment, 3) specialist imaging techniques identifying Optimizing Rectal Cancer Management: Analysis of Current Evidence
Annals of Gastroenterology, 2016
In rectal cancer management, accurate staging by magnetic resonance imaging, neo-adjuvant treatment with the use of radiotherapy, and total mesorectal excision have resulted in remarkable improvement in the oncological outcomes. However, there is substantial discrepancy in the therapeutic approach and failure to adhere to international guidelines among different Greek-Cypriot hospitals. The present guidelines aim to aid the multidisciplinary management of rectal cancer, considering both the local special characteristics of our healthcare system and the international relevant agreements (ESMO, EURECCA). Following background discussion and online communication sessions for feedback among the members of an executive team, a consensus rectal cancer management was obtained. Statements were subjected to the Delphi methodology voting system on two rounds to achieve further consensus by invited multidisciplinary international experts on colorectal cancer. Statements were considered of high, moderate or low consensus if they were voted by ≥80%, 60-80%, or <60%, respectively; those obtaining a low consensus level after both voting rounds were rejected. One hundred and two statements were developed and voted by 100 experts. The mean rate of abstention per statement was 12.5% (range: 2-45%). In the end of the process, all statements achieved a high consensus. Guidelines and algorithms of diagnosis and treatment were proposed. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized.