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. 2022 Sep 2;6(5):zrac098.
doi: 10.1093/bjsopen/zrac098.

Changing patterns of multidisciplinary team treatment, early mortality, and survival in colorectal cancer

David M Layfield  1 , Karen G Flashman  1 , Sara Benitez Majano  2 , Asha Senapati  1 , Christopher Ball  1 , John A Conti  1 , Jim S Khan  1 , Daniel P O'Leary  1
Affiliations

Changing patterns of multidisciplinary team treatment, early mortality, and survival in colorectal cancer

David M Layfield et al. BJS Open. .

Abstract

Background: This study reports early mortality and survival from colorectal cancer in relation to the pattern of treatments delivered by the multidisciplinary team (MDT) meeting at a high-volume institution in England over 14 years.

Methods: All patients diagnosed with colorectal cancer and discussed during MDT meetings from 2003 to 2016 at a single institution were reviewed. Three time intervals (2003-2007, 2008-2012, and 2013-2016) were compared regarding initial surgical management (resection, local excision, non-resection surgery, and no surgery), initial oncological therapy, 90-day mortality, and crude 2-year survival for the whole cohort. Sub-analyses were performed according to age greater or less than 80 years.

Results: The MDT managed 4617 patients over 14 years (1496 in the first interval and 1389 in the last). Over this time, there was a reduction in emergency resections from 15.5 per cent to 9.0 per cent (P < 0.0001); use of oncological therapies increased from 34.6 per cent to 41.6 per cent (P < 0.0001). The 90-day mortality after diagnosis of colorectal cancer dropped from 14.8 per cent to 10.7 per cent (P < 0.001) and 2-year survival improved from 58.6 per cent to 65 per cent (P < 0.001). Among patients aged 80 years or older (425 and 446, in the first and last intervals respectively) there was, in addition, a progressive increase in 'no surgery' rate from 33.6 per cent to 50.2 per cent (P < 0.0001) and a reduction in elective resections from 42.4 per cent to 33.9 per cent (P = 0.010). The 90-day mortality after elective resection fell from 10.0 per cent (18 of 180) to 3.3 per cent (5 of 151; P = 0.013).

Conclusions: Survival from colorectal cancer improved significantly over 14 years. Among patients aged ≥80 years, major changes in the type of treatment delivered were associated with a decrease in postoperative mortality.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curves for all patients diagnosed with colorectal cancer by age and time interval as in Tables 3 and 4 Significance values refer to survival among all patients diagnosed 2013–2016 compared with 2003–2007.
See this image and copyright information in PMC

Comment in

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