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Fehervari M, Hamrang-Yousefi S, Fadel MG, Mills SC, Warren OJ, Tekkis PP, Kontovounisios C. A systematic review of colorectal multidisciplinary team meetings: an international comparison. BJS Open 2021; 5:6278497. [PMID: 34013317 PMCID: PMC8134530 DOI: 10.1093/bjsopen/zrab044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/11/2021] [Indexed: 01/31/2023] Open
Abstract
Background Colorectal multidisciplinary teams (CR MDTs) were introduced to enhance the cancer care pathway and allow for early investigation and treatment of cancer. However, there are no ‘gold standards’ set for this process. The aim of this study was to review the literature systematically and provide a qualitative analysis on the principles, organization, structure and output of CR MDTs internationally. Methods Literature on the role of CR MDTs published between January 1999 and March 2020 in the UK, USA and continental Europe was evaluated. Historical background, structure, core members, education, frequency, patient-selection criteria, quality assurance, clinical output and outcomes were extracted from data from the UK, USA and continental Europe. Results Forty-eight studies were identified that specifically met the inclusion criteria. The majority of hospitals held CR MDTs at least fortnightly in the UK and Europe by 2002 and 2005 respectively. In the USA, monthly MDTs became a mandatory element of cancer programmes by 2013. In the UK, USA and in several European countries, the lead of the MDT meeting is a surgeon and core members include the oncologist, specialist nurse, histopathologist, radiologist and gastroenterologist. There were differences observed in patient-selection criteria, in the use of information technology, MDT databases and quality assurance internationally. Conclusion CR MDTs are essential in improving the patient care pathway and should express clear recommendations for each patient. However, a form of quality assurance should be implemented across all MDTs.
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Affiliation(s)
- M Fehervari
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | | | - M G Fadel
- Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - S C Mills
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - O J Warren
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
| | - P P Tekkis
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK.,Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - C Kontovounisios
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Colorectal Surgery, Chelsea and Westminster Hospital, London, UK.,Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
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Žilinskas J, Jokubauskas M, Smailytė G, Gineikienė I, Tamelis A. Comparison of Changes in Disease-Free and Overall Survival of Resectable Rectal Adenocarcinoma between 2010 and 2015. Visc Med 2020; 36:144-149. [PMID: 32355671 DOI: 10.1159/000500730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/02/2019] [Indexed: 11/19/2022] Open
Abstract
Background Management of rectal cancer (RC) has undergone many changes in recent decades. A multidisciplinary approach to this complex disease is essential, ensuring high-quality diagnostic, treatment, and outcomes. We aimed to compare treatment results of RC in a single-centre setting between 2010 and 2015. Methods A retrospective comparative study included patients with newly diagnosed and operated resectable RC. Patients' diagnostic and treatment data were analysed. Postoperative morbidity was measured according to the Clavien-Dindo classification. Survival data were received from the Lithuanian Cancer Registry. Continuous variables were expressed as mean and SD. Student t test and one-way ANOVA were used for parametric data and the Mann-Whitney test for non-parametric. A multivariate logistic regression analysis was used to identify independent factors for increased survival. Association between categorical variables was verified using Pearson χ<sup>2</sup>. Results The study included 179 patients: 80 from 2010 and 99 from 2015. Mean sample age was 67.1 ± 10.7 years. There was no significant difference regarding age, gender, median ASA (3 in both groups), but mean hospital stay was 2 days shorter (8 vs. 10 days) in 2015 (p = 0.002). There were only 8 patients (4%) admitted to the hospital on an emergency basis. Pelvis MRI and abdominal CT were performed more often in 2015: from 37.5 to 77.8% (p < 0.001) and from 52.5 to 97% in 2015, respectively. Circumferential margin evaluation increased from 13.8 to 36.4% (p = 0.001). Neoadjuvant therapy increased from 20% in 2010 to 44.9% in 2015 (p = 0.01). The overall postoperative Clavien-Dindo complication rate was higher in 2015 (13.8 vs. 20.2%, p = 0.596), but in-hospital mortality was lower (1 vs. 0 patients). Comparison of radiological TNM and pathological TNM with one-way ANOVA showed a significant difference staging between 2010 (p = 0.002) and 2015 (p = 0.001). The 2-year overall survival (OS) increased from 76.3 to 86.9% (p = 0.046) and the median disease-free survival from 27 (range 0-35) months to 28 (range 0-35) months (72.5-83.5%, p = 0.077). Multivariate logistic regression analysis determined that availability and performance of MRI were associated with an increased OS (OR = 1.529, 95% CI 0.916-2.554, p = 0.020). Conclusions The expanded quantity of preoperative imaging, an improved radiological staging, and compulsory multidisciplinary team board discussions have led to selective neoadjuvant treatment decision followed by surgery which can positively affect the 2-year OS rate.
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Affiliation(s)
- Justas Žilinskas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Mantas Jokubauskas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Giedrė Smailytė
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania
| | - Irina Gineikienė
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Algimantas Tamelis
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
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Wang XH, Liu ZJ, Xu JB, Li FQ, Li WL, Cao WT, Zhou ZY. Baseline and early 3D-CUBE volume reconstruction of locally advanced rectal cancer to predict tumor response after neoadjuvant chemotherapy. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:231-241. [PMID: 31929131 DOI: 10.3233/xst-190594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To explore whether volumetric measurements of 3D-CUBE sequences based on baseline and early treatment time can predict neoadjuvent chemotherapy (NCT) efficacy of locally advanced rectal cancer (LARC). MATERIAL AND METHOD 73 patients with LARC were enrolled from February 2014 to January 2018. All patients underwent MRIs during the baseline period before NCT (BL-NCT) and the first month of NCT (FM-NCT), and tumor volume (TV) was measured using 3D-CUBE, and tumor volume reduction (TVR) and tumor volume reduction rate (TVRR) were calculated. In addition, tumor invasion depth, tumor maximal length, range of tumor involvement in the circumference of intestinal lumen and distance from inferior part of tumor to the anal verge were measured using baseline high-spatial-resolution T2-weighted MRIs. All patients were categorized into sensitive and insensitive groups based on post-surgical pathology after completion of the full courses of NCT. The receiver operating characteristic (ROC) curve was used to analyze the value of different MRI parameters in predicting efficacy of NCT. RESULTS Statistically significant differences in TV of BL-NCT, TVR and TVRR from BL-NCT to FM-NCT were detected between sensitive and insensitive groups (P < 0.05, respectively). The areas under the curves (AUC) of ROC of TVR and TVRR in predicting efficacy of NCT (0.890 [95% CI, 0.795∼0.951], 0.839 [95% CI, 0.735∼0.915]) were significantly better than that of TV (0.660 [95% CI, 0.540∼0.767]) (P < 0.05, respectively). CONCLUSION Reconstruction of 3D-CUBE volume in the first month of NCT is necessary, and both TVR and TVRR can be used as early predictors of NCT efficacy.
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Affiliation(s)
- Xin-Hua Wang
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Zheng-Jun Liu
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Jian-Bo Xu
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Fang-Qian Li
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Wen-Li Li
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Wu-Teng Cao
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Zhi-Yang Zhou
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
- Guangzhou Universal Medical Imaging Diagnostic Center, Guangzhou, China
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