Please use this identifier to cite or link to this item: http://192.168.1.35:80/jspui/handle/Hannan/31601
Title: Selection process can improve the outcome in locally advanced and recurrent colorectal cancer: activity and results of a dedicated multidisciplinary colorectal cancer centre.
Authors: Kontovounisios, C;Tan, E;Pawa, N;Brown, G;Tait, D;Cunningham, D;Rasheed, S;Tekkis, P
subject: Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
Surgery
Beyond TME
MDT
locally advanced and recurrent rectal cancer
TOTAL PELVIC EXENTERATION
TOTAL MESORECTAL EXCISION
SURGEON-RELATED FACTORS
CALMAN-HINE REPORT
RECTAL-CANCER
SURGICAL-MANAGEMENT
PREOPERATIVE RADIOTHERAPY
ESOPHAGEAL CANCER
SINGLE-CENTER
survival
Beyond TME
MDT
locally advanced and recurrent rectal cancer
Colectomy
Colorectal Neoplasms
Humans
Neoplasm Recurrence, Local
Patient Care Team
Patient Selection
Pelvic Exenteration
Quality of Life
Referral and Consultation
Treatment Outcome
United Kingdom
Humans
Colorectal Neoplasms
Neoplasm Recurrence, Local
Treatment Outcome
Colectomy
Pelvic Exenteration
Patient Selection
Quality of Life
Referral and Consultation
Patient Care Team
United Kingdom
Clinical Sciences
Surgery
Year: 6-Oct-2016
Publisher: Wiley
Description: AIM: There is wide disparity in the care of patients with multi-visceral involvement of rectal cancer. The results of treatment of advanced and recurrent colorectal cancer are presented 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 length of stay (LOS) varied from 13.3-19.9 days. RR operations had the highest morbidity (Clavien-Dindo [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 standardised referral pathway is encouraged. This article is protected by copyright. All rights reserved.
URI: http://localhost/handle/Hannan/31601
https://spiral.imperial.ac.uk:8443/handle/10044/1/41147
Standard no: 1463-1318
https://dx.doi.org/10.1111/codi.13517
Type Of Material: Article
Appears in Collections:Department of Surgery and Cancer

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