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

• Published in: Annals of the Royal College of Surgeons of England 2022-09, Vol.104 (8), p.611-617
• Main Authors: Harji, D P, Houston, F, Cutforth, I, Hawthornthwaite, E, McKigney, N, Sharpe, A, Coyne, P, Griffiths, B
• Format: Article
• Language: English
• 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
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/rcsann.2022.0045

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;