The impact of multidisciplinary team decision-making in locally advanced and recurrent rectal cancer

Appropriate patient selection within the context of a multidisciplinary team (MDT) is key to good clinical outcomes. The current evidence base for factors that guide the decision-making process in locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) is limited to anatomic...

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Bibliographic Details
Published in:	Annals of the Royal College of Surgeons of England Vol. 104; no. 8; pp. 611 - 617
Main Authors:	Harji, D P, Houston, F, Cutforth, I, Hawthornthwaite, E, McKigney, N, Sharpe, A, Coyne, P, Griffiths, B
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 01-09-2022 Royal College of Surgeons
Subjects:	Cancer therapies Chemotherapy Colorectal cancer Comorbidity Decision making General Surgery Humans Medical referrals Metastasis Multidisciplinary teams Neoadjuvant Therapy Neoplasm Recurrence, Local - epidemiology Neoplasm Recurrence, Local - pathology Neoplasm Recurrence, Local - therapy Ostomy Palliative care Patient Care Team Patients Pelvis Prospective Studies Radiation therapy Rectal Neoplasms - pathology Rectal Neoplasms - surgery Retrospective Studies Surgery Tomography Tumors Local neoplasm recurrence Rectal neoplasms Clinical decision-making Colorectal surgery
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Summary:	Appropriate patient selection within the context of a multidisciplinary team (MDT) is key to good clinical outcomes. The current evidence base for factors that guide the decision-making process in locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) is limited to anatomical factors. A registry-based, prospective cohort study was undertaken of patients referred to our specialist MDT between 2015 and 2019. Data were collected on patients and disease characteristics including performance status, Charlson Comorbidity Index, the English Index of Multiple Deprivation quintiles and MDT treatment decision. Curative treatment was defined as neoadjuvant treatment and surgical resection that would achieve a R0 resection, and/or complete treatment of distant metastatic disease. Palliative treatment was defined as non-surgical treatment. In total, 325 patients were identified; 72.7% of patients with LARC and 63.6% of patients with LRRC were offered treatment with curative intent ( = 0.08). Patients with poor performance status (PS > 2; < 0.001), severe comorbidity ( < 0.001), socio-economic deprivation ( = 0.004), a positive predictive circumferential resection margin ( = 0.005) and metastatic disease ( < 0.001) were associated with palliative treatment. Overall survival in the curative cohort was 49 months (95% confidence interval [CI] 32.4-65.5) compared with 12 months (95% CI 9.1-14.9) in the palliative cohort ( < 0.001). The presence of metastatic disease was identified as a prognostic factor for patients undergoing curative treatment ( = 0.05). The only prognostic factor identified in patients treated palliatively was performance status ( < 0.001). Our study identifies a number of preoperative, prognostic factors that affect MDT decision-making and overall survival.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0035-8843 1478-7083
DOI:	10.1308/rcsann.2022.0045