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. 2022 Sep;104(8):611-617.
doi: 10.1308/rcsann.2022.0045. Epub 2022 May 31.

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

D P Harji  1 , F Houston  1 , I Cutforth  1 , E Hawthornthwaite  1 , N McKigney  1 , A Sharpe  2 , P Coyne  2 , B Griffiths  2
Affiliations

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

D P Harji et al. Ann R Coll Surg Engl. 2022 Sep.

Abstract

Introduction: 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.

Methods: 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.

Results: 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 (p = 0.08). Patients with poor performance status (PS > 2; p < 0.001), severe comorbidity (p < 0.001), socio-economic deprivation (p = 0.004), a positive predictive circumferential resection margin (p = 0.005) and metastatic disease (p < 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 (p < 0.001). The presence of metastatic disease was identified as a prognostic factor for patients undergoing curative treatment (p = 0.05). The only prognostic factor identified in patients treated palliatively was performance status (p < 0.001).

Conclusions: Our study identifies a number of preoperative, prognostic factors that affect MDT decision-making and overall survival.

Keywords: Clinical decision-making; Colorectal surgery; Local neoplasm recurrence; Rectal neoplasms.

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Figures

Figure 1
Figure 1
Treatment strategies and outcomes following multidisciplinary team decision-making
Figure 2
Figure 2
Kaplan–Meier analysis of overall survival in patients with curative treatment intent vs palliative treatment intent, p < 0.001
See this image and copyright information in PMC

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