How Is Rectal Cancer Managed: a Survey Exploring Current Practice Patterns in Canada

Crawford, Ayrianne J.; Firtell, Jill A.; Caycedo‐Marulanda, Antonio

doi:10.1007/s12029-018-0064-9

Cited by 12 publications

(11 citation statements)

References 60 publications

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“…The survey yielded response from hospital representatives from various regions of the country. Moreover, comparable surgeon response rates were reported in other studies [21,[23][24][25][26].…”

Section: Discussionsupporting

confidence: 86%

Major differences in follow-up practice of patients with colorectal cancer; results of a national survey in the Netherlands

Qaderi

Wijffels²,

Bremers

et al. 2020

BMC Cancer

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Background: The precise content and frequency of follow-up of patients with colorectal cancer (CRC) is variable and guideline adherence is low. The aim of this study was to assess the view of colorectal surgeons on their local follow-up schedule and to clarify their opinions about risk-stratification and organ preserving therapies. Equally important, adherence to the Dutch national guidelines was determined. Methods: Colorectal surgeons were invited to complete a web-based survey about the importance and interval of clinical follow-up, CEA monitoring and the use of imaging modalities. Furthermore, the opinions regarding physical examination, risk-stratification, organ preserving strategies, and follow-up setting were assessed. Data were analyzed using quantitative and qualitative analysis methods. Results: A total of 106 colorectal surgeons from 52 general and 5 university hospitals filled in the survey, yielding a hospital response rate of 74% and a surgeon response rate of 42%. The follow-up of patients with CRC was mainly done by surgeons (71%). The majority of the respondents (68%) did not routinely perform physical examination during follow-up of rectal patients. Abdominal ultrasound was the predominant modality used for detection of liver metastases (77%). Chest X-ray was the main modality for detecting lung metastases (69%). During the first year of follow-up, adherence to the minimal guideline recommendations was high (99-100%). The results demonstrate that, within the framework of the guidelines, some respondents applied a more intensive follow-up and others a less intensive schedule. The majority of the respondents (77%) applied one single follow-up imaging schedule for all patients that underwent treatment with curative intent. Conclusions: Dutch colorectal surgeons' adherence to minimal guideline recommendations was high, but within the guideline framework, opinions differed about the required intensity and content of clinical visits, the interval of CEA monitoring, and the importance and frequency of imaging techniques. This national survey demonstrates current follow-up practice throughout the Netherlands and highlights the follow-up differences of curatively treated patients with CRC.

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Section: Discussionsupporting

confidence: 86%

Major differences in follow-up practice of patients with colorectal cancer; results of a national survey in the Netherlands

Qaderi

Wijffels²,

Bremers

et al. 2020

BMC Cancer

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“…This variation is similar to what was found in a recent survey by Crawford and colleagues that looked at trends in the management of rectal cancer in Canada. 12 In this study, 51% (21/41) of the participating surgeons stated that they operated on more than 20 cases of rectal cancer per year, with 9% of them operating on fewer than 5 cases per year. 12 Although the data assessing volume outcomes for rectal cancer are inconsistent, with some studies showing a relationship and others not, low volumes of rectal cancer cases could prove to be a problem if surgeons are trying to add TaTME to their skill set.…”

Section: Discussionmentioning

confidence: 67%

“…12 In this study, 51% (21/41) of the participating surgeons stated that they operated on more than 20 cases of rectal cancer per year, with 9% of them operating on fewer than 5 cases per year. 12 Although the data assessing volume outcomes for rectal cancer are inconsistent, with some studies showing a relationship and others not, low volumes of rectal cancer cases could prove to be a problem if surgeons are trying to add TaTME to their skill set. [13][14][15][16][17] Indeed, 25% of our cohort of surgeons who operated on 8 or fewer rectal cancer cases per year said they planned to learn TaTME.…”

Section: Discussionmentioning

confidence: 67%

“…The number of surgeons in our study already performing TaTME was significantly higher than the number reported by Crawford and colleagues (23 versus 4). 12 This might be related to the fact that Crawford and colleagues included only members of the Canadian Society of Colon and Rectal Surgeons in their study, whereas our work demonstrates that both surgical oncologists and minimally invasive surgeons have also adopted TaTME. On the other hand, this increase might reflect the rapid pace of adoption of TaTME.…”

Section: Discussionmentioning

confidence: 82%

“…(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) 9(5)(6)(7)(8)(9)(10) IQR = interquartile range; TaTME = transanal total mesorectal excision. *Surgeons who were performing TaTME at the time of the survey.†Surgeons who were not performing TaTME at the time of the survey.…”

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confidence: 99%

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Implementing new surgical technology: a national perspective on case volume requirement for proficiency in transanal total mesorectal excision

Palter

Montbrun

2020

CJS

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Background: Early data suggest that transanal total mesorectal excision (TaTME) is a safe alternative to the abdominal approach for rectal cancer. This study aims to understand the approach to the management of rectal cancer in Canada and to ascertain perspectives on introducing TaTME. Methods: Surgeons were invited to complete a survey that asked about their management practices relating to rectal cancer and their opinions regarding TaTME. Results: Ninety-four surgeons completed the survey (38% response rate). The number of rectal cancer cases handled annually by surgeons varied widely (1-80 cases, median 15 cases). Twenty-seven percent of respondents performed TaTME at the time of the survey, and 43% of those who did not said they planned on learning the technique. Surgeons who performed TaTME felt that a higher annual volume of rectal cancer cases was required to maintain proficiency than did non-TaTME surgeons (median 20 cases [interquartile range (IQR) 15-25 cases] v. 15 cases [IQR 10-20 cases]). Surgeons who performed TaTME also felt that a higher annual volume of TaTME cases was required to maintain proficiency (median 12 cases [IQR 10-19 cases] v. 9 cases [IQR 5-10 cases]). Conclusion: These findings help define the current practice environment for rectal cancer surgeons in Canada and highlight the complex issues associated with learning TaTME. Contexte : Selon des données préliminaires, l'exérèse totale du mésorectum par voie transanale (ou TaTME, pour transanal total mesorectal excision) est une solution de rechange sécuritaire à l'approche abdominale pour le cancer du rectum. Cette étude vise à faire le point sur le traitement du cancer rectal au Canada et à mesurer l'intérêt à l'endroit de la technique TaTME. Méthodes : Des chirurgiens ont été invités à répondre à un sondage sur leur façon de prendre en charge le cancer rectal et sur leur opinion au sujet de la TaTME.

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A Snapshot of the International Views of the Treatment of Rectal Cancer Patients, a Multi‐regional Survey: International Tendencies in Rectal Cancer

et al. 2020

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Background: Management of rectal cancer has a number of potentially appropriate alternatives for each patient. Despite acceptance of standards, practices may vary among regions. There is significant paucity of data in this area. The objective was to create a snapshot of the regional differences.Design: This online survey included 10 questions. Enquiries focused on controversial topics, on surgeon and hospital volume, surgical margins, appropriateness of surgical approaches and techniques, Watch and Wait strategies and total neoadjuvant therapy. Major colorectal surgery societies around the world were asked to invite their members to complete the survey.Outcomes measures: Frequency of responses across regions within each question was compared by Fisher's exact test.Results: 753 participants from 60 countries responded. 8 regions were identified, 4 had sufficient representation for comparisons. Similarities and differences in the therapies amongst these regions were identified. Robotic surgery penetrance is higher in North America, watch and wait is more accepted in South America. Patients in Oceania are more likely to be diverted, Europe has more usage of taTME.Discussion: This online survey was practical as a mean to provide a rapid assessment of the international picture on consistency and variability of rectal cancer patients care, and to potentially identify opportunities to standardized care to patients. Medical surveys have inherent limitations, pertinent to our study is selection bias is one.Conclusions: The management of rectal cancer varies among different regions. Identification of differences is important when considering global efforts to improve management and interpret data.

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How Is Rectal Cancer Managed: a Survey Exploring Current Practice Patterns in Canada

Cited by 12 publications

References 60 publications

Major differences in follow-up practice of patients with colorectal cancer; results of a national survey in the Netherlands

Major differences in follow-up practice of patients with colorectal cancer; results of a national survey in the Netherlands

Implementing new surgical technology: a national perspective on case volume requirement for proficiency in transanal total mesorectal excision

A Snapshot of the International Views of the Treatment of Rectal Cancer Patients, a Multi‐regional Survey: International Tendencies in Rectal Cancer

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