Benchmarking trial between France and Australia comparing management of primary rectal cancer beyond TME and locally recurrent rectal cancer (PelviCare Trial): rationale and design

The compassionate care framework plus quality control group improves the quality of postoperative nursing management for patients in anorectal surgery: An observational study

OBJECTIVE

This study aimed to investigate the effectiveness of the joint application of the compassionate care framework (CCF) and a quality control (QC) team in improving the quality of postoperative nursing management for patients in anorectal surgery.

METHODS

Patients who underwent anorectal surgery at the China-Japan Friendship Hospital between May 2022 and December 2022 were selected by convenience sampling. A digital random generator was used for random grouping. The odd numbers entered the control group (n = 53) and the even numbers entered the study group (n = 53). The control group received postoperative traditional nursing, and the study group received postoperative nursing and QC team management. A questionnaire survey was used to analyse patients' satisfaction with nursing. The two groups were compared for nursing quality scores, patient satisfaction with nursing care and incidence of complications.

RESULTS

After management, compared with the control group, the study group scored significantly higher for the nursing process, environmental management, emergency response and safety protection (p < 0.05 for all). The study group also exhibited higher satisfaction scores with the nursing process, nurse-patient relationship and service attitude compared with the control group (p < 0.05 for all). The complication incidence rate in the study group was significantly lower than in the control group (p < 0.05).

CONCLUSION

The combined use of the CCF and a QC team can effectively improve the quality of postoperative nursing management for patients in anorectal surgery, reduce the incidence of complications and enhance patient satisfaction with nursing care, thus holding significant potential for wider application.

Measurement that matters: A systematic review and modified Delphi of multidisciplinary colorectal cancer quality indicators

AIM

To develop a priority set of quality indicators (QIs) for use by colorectal cancer (CRC) multidisciplinary teams (MDTs).

METHODS

The review search strategy was executed in four databases from 2009-August 2019. Two reviewers screened abstracts/manuscripts. Candidate QIs and characteristics were extracted using a tailored abstraction tool and assessed for scientific soundness. To prioritize candidate indicators, a modified Delphi consensus process was conducted. Consensus was sought over two rounds; (1) multidisciplinary expert workshops to identify relevance to Australian CRC MDTs, and (2) an online survey to prioritize QIs by clinical importance.

RESULTS

A total of 93 unique QIs were extracted from 118 studies and categorized into domains of care within the CRC patient pathway. Approximately half the QIs involved more than one discipline (52.7%). One-third of QIs related to surgery of primary CRC (31.2%). QIs on supportive care (6%) and neoadjuvant therapy (6%) were limited. In the Delphi Round 1, workshop participants (n = 12) assessed 93 QIs and produced consensus on retaining 49 QIs including six new QIs. In Round 2, survey participants (n = 44) rated QIs and prioritized a final 26 QIs across all domains of care and disciplines with a concordance level > 80%. Participants represented all MDT disciplines, predominantly surgical (32%), radiation (23%) and medical (20%) oncology, and nursing (18%), across six Australian states, with an even spread of experience level.

CONCLUSION

This study identified a large number of existing CRC QIs and prioritized the most clinically relevant QIs for use by Australian MDTs to measure and monitor their performance.

Development and validation of a high-resolution T2WI-based radiomic signature for the diagnosis of lymph node status within the mesorectum in rectal cancer

Purpose

The aim of this study was to explore the feasibility of a high-resolution T2-weighted imaging (HR-T2WI)-based radiomics prediction model for diagnosing metastatic lymph nodes (LNs) within the mesorectum in rectal cancer.

Method

A total of 604 LNs (306 metastatic and 298 non-metastatic) from 166 patients were obtained. All patients underwent HR-T2WI examination and total mesorectal excision (TME) surgery. Four kinds of segmentation methods were used to select region of interest (ROI), including method 1 along the border of LNs; method 2 along the expanded border of LNs with an additional 2–3 mm; method 3 covering the border of LNs only; and method 4, a circle region only within LNs. A total of 1,409 features were extracted for each method. Variance threshold method, Select K Best, and Lasso algorithm were used to reduce the dimension. All LNs were divided into training and test sets. Fivefold cross-validation was used to build the logistic model, which was evaluated by the receiver operating characteristic (ROC) with four indicators, including area under the curve (AUC), accuracy (ACC), sensitivity (SE), and specificity (SP). Three radiologists with different working experience in diagnosing rectal diseases assessed LN metastasis respectively. The diagnostic efficiencies with each of four segmentation methods and three radiologists were compared to each other.

Results

For the test set, the AUCs of four segmentation methods were 0.820, 0.799, 0.764, and 0.741; the ACCs were 0.725, 0.704, 0.709, and 0.670; the SEs were 0.756, 0.634, 0.700, and 0.589; and the SPs were 0.696, 0.772, 0.717, and 0.750, respectively. There was no statistically significant difference in AUC between the four methods (p > 0.05). Method 1 had the highest values of AUC, ACC, and SE. For three radiologists, the overall diagnostic efficiency was moderate. The corresponding AUCs were 0.604, 0.634, and 0.671; the ACCs were 0.601, 0.632, and 0.667; the SEs were 0.366, 0.552, and 0.392; and the SPs were 0.842, 0.715, and 0.950, respectively.

Conclusions

The proposed HR-T2WI-based radiomic signature exhibited a robust performance on predicting mesorectal LN status and could potentially be used for clinicians in order to determine the status of metastatic LNs in rectal cancer patients.

An MRI-based multi-objective radiomics model predicts lymph node status in patients with rectal cancer

PURPOSE

To apply a multi-objective radiomics model based on pre-operative magnetic resonance imaging (MRI) for improving diagnostic accuracy of LN metastasis in rectal cancer patients.

METHODS

This study consisted of 91 patients diagnosed with rectal cancer from April 2018 to March 2019. All patients underwent rectal MRI before surgery without any other treatment. Clinical data, subjective radiologist assessments, and radiomic features of LNs were obtained. A total of 1409 radiomic features were extracted from T2WI LN images. Multi-objective optimization with the iterative multi-objective immune algorithm (IMIA) was used to select radiomic features to build prediction models. Predictive performances of radiomic, radiologist, and combined radiomic and radiologist models were assessed for accuracy by receiver operating characteristics (ROC) curves.

RESULTS

For the radiologist analysis, heterogeneity was the only significant independent predictor of LN status. The sensitivity, specificity, and accuracy of the subjective radiologist analysis were 72.09%, 73.81%, and 78.12%, respectively. The sensitivity, specificity, and accuracy of the solitary radiomic model consisting of 10 features were 89.81%, 82.57%, and 87.77%, respectively. The sensitivity, specificity, and accuracy of the combined model, which consisted of 12 radiomic and radiologist features, were 92.23%, 84.69%, and 89.88%, respectively. The combined model had the best prediction performance with an AUC of 0.94.

CONCLUSIONS

The multi-objective radiomics model based on T2WI images was very useful in predicting pre-operative LN status in rectal cancer patients.

International variation in managing locally advanced or recurrent rectal cancer: prospective benchmark analysis

BACKGROUND

Tumour extension beyond the mesorectal plane (ymrT4) occurs in 5-10 per cent of patients with rectal cancer and 10 per cent of patients develop locally recurrent rectal cancer (LRRC) after primary surgery. There is global variation in healthcare delivery for these conditions.

METHODS

An international benchmark trial of the management of ymrT4 tumours and LRRC was undertaken in France and Australia between 2015 and 2017. Heterogeneity in management and operative decision-making were analysed by comparison of surgical resection rates, blinded intercountry reading of pelvic MRI, quality-of-life assessment and qualitative evaluations.

RESULTS

Among 154 patients (97 in France and 57 in Australia), 31·8 per cent had ymrT4 disease and 68·2 per cent LRRC. The surgical resection rates were 88 and 79 per cent in France and Australia respectively (P = 0·112). The concordance in operative planning was low (κ = 0·314); the rate of pelvic exenteration was lower in France than Australia both in clinical practice (36 of 78 versus 34 of 40; P < 0·001) and in theoretical conditions (10 of 25 versus 50 of 57; P = 0·002). The R0 resection rate was lower in France than Australia for LRRC (25 of 49 versus 18 of 21; P = 0·007) but not for ymrT4 tumours (21 of 26 versus 15 of 15; P = 0·139). Morbidity rates were similar. Patients who underwent non-exenterative procedures had higher scores on the mental functioning subscale at 12 months (P = 0·047), and a lower level of distress at 6 months (P = 0·049). Qualitative analysis highlighted five categories of psychosocial factors influencing treatment decisions: patient, strategy, specialist, organization and culture.

CONCLUSION

This international benchmark trial has highlighted the differences in worldwide treatment of locally advanced and LRRC. Standardized care should improve outcomes for these patients.

The development of a regional referral pathway for locally recurrent rectal cancer: A Delphi consensus study

BACKGROUND

The management of patients with locally recurrent rectal cancer (LRRC) is often complex and requires multidisciplinary input whereas only few patients are referred to a specialist centre. The aim of this study was to design a regional referral pathway for LRRC, in Nouvelle Aquitaine (South-West, France).

METHODS

In 2016, we conducted with a Study Steering Committee (SC) a three phase mixed-methods study including identification of key factors, identification of key stakeholders and Delphi voting consensus. During three rounds of Delphi voting, a consensus was defined as favorable, if at least 80% of participating experts rate the factor, below or equal to 3/10 using a Likert scale, or consider it as "useful" using a binary scale (third round only). Finally, the SC drafted guidelines.

RESULTS

Among the 423 physicians involved in 29 regional digestive Multi-Disciplinary Team (MDT) meeting, 59 participants (from 26 MDT meeting) completed all three rounds of Delphi voting. Thirteen out of twenty initially selected factors reached a favorable consensus. All patients with a LRRC need to be included into a referral pathway. Patients with a central pelvic recurrence offered curative treatment in their local hospital and patients with unresectable metastatic disease were excluded of the referral. Key performance indicators were also agreed including the time to referral and completion of pelvic MRI-, CT-, PET-scan prior to MDT referral.

CONCLUSION

The development of this referral pathway represents an innovative health service, which will improve the management of patients with LRRC in France.