Value of multi-disciplinary input into laparoscopic management of rectal cancer-An observational study

• Published in: World journal of gastrointestinal surgery Vol. 9; no. 6; pp. 153 - 160
• Main Authors: Dhruva Rao, Pawan Kumar, Peiris, Sooriyaratchige Pradeep Manjula, Arif, Seema Safia, Davies, Rhodri A, Masoud, Ashraf Gergies, Haray, Puthucode Narayanan
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 27-06-2017
• Subjects: Observational Study; Multi-disciplinary management; Rectal cancer; Laparoscopic rectal resection outcomes
• ISSN: 1948-9366; 1948-9366
• DOI: 10.4240/wjgs.v9.i6.153

AIM To assess the impact of multi-disciplinary teams(MDTs)management in optimising the outcome for rectal cancers.METHODS We undertook a retrospective review of a prospectively maintained database of patients with rectal cancers(defined as tumours≤15 cm from anal verge)discussed at our MDT between Jan 2008 and Jan 2011.The data was validated against the national database to ensure completeness of dataset.The clinical course and follow-up data was validated using the institution’s electronic patient records.The data was analysed in terms of frequencies and percentages.Significance of any differences were analysed usingχ2 test.A Kaplan-Meier analysis was performed for overall survival and disease free survival.RESULTS Following appropriate staging,one hundred and thirtythree patients were suitable for potentially curative resections.Seventy two(54%)were upper rectal cancer(URC)-tumour was>6 cm from the anal verge and 61(46%)were lower rectal cancers(LRC)-lower extent of the tumour was palpable≤6 cm.Circumferential resection margin(CRM)appeared threatened on preoperative MRI in 19/61(31%)patients with LRC requiring neo-adjuvant therapy(NAT).Of the 133 resections,118(89%)were attempted laparoscopically(5%conversion rate).CRM was positive in 9(6.7%)patients;Median lymph node harvest was 12(2-37).Major complications occurred in 8(6%)patients.Median follow-up was 53 mo(0-82).The 90-d mortality was 2(1.5%).Over the followup period,disease related mortality was 11(8.2%)and overall mortality was 39(29.3%).Four(3%)patients had local recurrence and 22(16.5%)patients had distant metastases.CONCLUSION Management of rectal cancers can be optimized with multidisciplinary input to attain acceptable long-term oncological outcomes even when incorporating a laparoscopic approach to rectal cancer resection.