Making an IMPACT: A priority setting consultation exercise to improve outcomes in patients with locally advanced, recurrent and metastatic colorectal cancer

Vallance, A; Harji, Deena; Fearnhead, Nicola; Acheson, AG; Adams, Katie; Adams, Richard; Alsina, Deborah; Antoniou, A; Arnott, Robert; Bach, Simon; Battersby, Nick; Bedford, Matthew; Beggs, Andrew D; Belcher, Elizabeth; Boulstridge, Lisa; Boyle, K.; Bradbury, Jo; Braun, Michael; Brown, Ewan; Brown, Gina; Burling, D; Cameron, Iain C.; Campbell, Kenneth L.; Carney, Kim; Cecil, Thomas D.; Chapman, M.; Chapman, Stephen J.; Chong, Peter Siao Tick; Coyne, Peter; Clark, Sue; Crane, Stacey; Daniels, Ian R.; Davies, Jeff; Davies, L. G.; Davies, Matthew; Dawson, Cindy; Dawson, Peter; Duff, M. J.; Demick, Anne; Elavia, K.; Gardner, R.; Evans, M. D.; Fenwick, Stephen; Galbraith, Sarah; Good, James; Gilbert, David; Griffiths, Ben; Hargest, Rachel; Hill, J; Hompes, Roel; Huguet, Emmanuel; Jenkins, Jordan; Kapur, Sandeep; Karandikar, Sharad; Katte, C.; Kumar, Naveena A. N.; Langman, Gerald; Lim, Madeleine S Y; Azevedo-Gilbert, R. Lopes de; Macdonald, Angus; Machesney, Michael; Mathur, Pawan; Maxwell‐Armstrong, C.; McArthur, D. Ray; McDermott, Francis T.; McDermott, Ultan; Mirnezami, A.; Mitchell, Patricia L.; Mohamed, Faheez; Moran, Brendan; Morris, Melissa; Murphy, Joshua; Nakas, Apostolos; Norris, C. M.; O’Dwyer, S T; Panagiotopoulou, IG; Pellino, Gianluca; Polignano, Francesco M.; Powell, Catherine; Renehan, Andrew G; Rowbottom, P.; Sagar, P. M.; Samuel, Leslie; Seligmann, Jenny F.; Shaikh, I.; Simpson, A.; Skaife, Paul; Skarrot, P.; Speake, William J.; Stearns, Adam T.; Stylianides, N; Sutton, Paul; Swarnkar, Keshav; Taylor, Claire; Tebala, Giovanni Domenico; Thorpe, Gabrielle; Tiernan, Jim; Toogood, Giles J.; Vimalchandran, Dale; Walker, Kate; Walsh, C. J.; Warren, Oliver; Wasan, Harpreet; Welsh, FK; Wheeler, J. M. D.; Whitley, Siobhan; Wilson, Mitchell P; Winter, Desmond C.; Youssef, Haney

doi:10.1016/j.ejso.2019.04.005

Cited by 17 publications

(10 citation statements)

References 15 publications

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“…The Association of Coloproctology of Great Britain and Ireland has recently highlighted the priorities for advanced CRC patients after engaging with patient groups and clinical stakeholders through the Improving the Management of Patients with Advanced Colorectal Tumours (IMPACT) initiative [ 13 ]. This was in response to the considerable variation in the surgical management of these patients and lack of evidence from high‐quality clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Pancreaticoduodenectomy with right hemicolectomy for advanced malignancy: a single UK hepatopancreaticobiliary centre experience

et al. 2022

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Aim Locally advanced intestinal neoplasms including colon cancer may require radical en bloc pancreaticoduodenectomy and right hemicolectomy (PD‐RC) to achieve curative, margin‐negative resection, but the safety and benefit of this uncommon procedure has not been established. The Association of Coloproctology of Great Britain and Ireland IMPACT initiative has also highlighted a lack of awareness about current services available within the UK for patients with advanced colorectal cancer and concerns about low‐volume centres managing complex cases. Thus, we aimed to review the feasibility, safety and long‐term outcomes of this procedure at a single high‐volume hepatopancreaticobiliary surgery unit in the UK. Method A retrospective cohort study was performed using a database of all consecutive patients with intestinal cancer who had been referred to our regional advanced multidisciplinary team and undergone PD‐RC in a 7‐year period (2013–2020). Clinico‐pathological and outcome data were reviewed. Results Ten patients (mean age 54 ± 13, 8/10 men) were identified. Final histology revealed the primary tumour sites were colon (n = 7) and duodenum (n = 3). R0 resection was achieved in all cases. The major complication rate (Clavien–Dindo ≥ 3) was 10% (1/10) with no deaths within 90 days of surgery. The Kaplan–Meier estimated 5‐year overall survival was 83.3% (95% CI 58.3%–100%). Univariate survival analysis identified perineural invasion and extra‐colonic origin as predictors of poor survival (log‐rank P < 0.05). Conclusion En bloc PD‐RC for locally advanced intestinal cancer can be performed safely with a high proportion of margin‐negative resections and resultant long‐term survival in carefully selected patients.

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Section: Introductionmentioning

confidence: 99%

Pancreaticoduodenectomy with right hemicolectomy for advanced malignancy: a single UK hepatopancreaticobiliary centre experience

et al. 2022

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“…Over the last decade there has been significant international interest and collaboration in improving outcomes in patients with LRRC, with an emphasis on generating high‐quality evidence to inform clinical decision‐making [3,28,29]. International collaboration is key to ensuring timely and successful recruitment to trials in difficult advanced cancer settings such as LRRC.…”

Section: Discussionmentioning

confidence: 99%

A phase III randomized trial evaluating chemotherapy followed by pelvic reirradiation versus chemotherapy alone as preoperative treatment for locally recurrent rectal cancer – GRECCAR 15 trial protocol

et al. 2021

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Aim: Treatment strategies in locally recurrent rectal cancer (LRRC) are complex and need to be balanced against previous treatments received for the primary rectal cancer.Radiotherapy is an important component of treatment in LRRC. However, there is little high-quality evidence on the role of reirradiation in this cohort. Therefore, the aim of this trial is to assess the efficacy of neoadjuvant chemotherapy followed by pelvic reirradiation versus neoadjuvant chemotherapy alone on the rate of curative surgery (R0) in previously irradiated patients with LRRC.Method: GRECCAR 15 is a prospective, multicentre, open-label, outcome assessorblinded, superiority randomized controlled phase III clinical trial comparing neoadjuvant chemotherapy followed by pelvic reirradiation versus neoadjuvant chemotherapy alone in patients with LRRC previously irradiated for the primary cancer. Adult patients (>18 years old) with a histologically proven resectable LRRC, who have previously received pelvic radiotherapy for their primary rectal cancer at a dose of 25-50.4 Gy, and an Eastern Cooperative Oncology Group performance status of <2 will be eligible to participate. The pelvic reirradiation will consist of conformational intensity-modulated external irradiation, delivering a dose of 30.6 Gy with concomitant chemotherapy using capecitabine.The primary outcome of this trial is the R0 resection rate. Overall, GRECCAR 15 aims to recruit 186 patients to detect an absolute difference of 20% in the R0 resection rate with 80% power and 5% two-sided significance level. Conclusion:The GRECCAR 15 trial is the first, definitive, phase III trial to investigate reirradiation in LRRC. The results of this trial will inform definitively the neoadjuvant treatment strategy in previously irradiated patients and assess whether there is any associated benefit of reirradiation in combination with induction chemotherapy in improving R0 resection rates.

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“…Available guidelines on colon and rectal cancer do not specifically recommend collecting this parameter [28, 29]. Thirty-day readmission might be an important quality indicator, worth including consistently within a standardization of reporting on the outcomes of bTME among other variables that need to be considered in patients with advanced colorectal cancers [5, 30, 31].…”

Section: Discussionmentioning

confidence: 99%

Predictors of short-term readmission after beyond total mesorectal excision for primary locally advanced and recurrent rectal cancer

et al. 2019

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Unplanned readmissions heavily affect the cost of health care and are used as an indicator of performance. No clear data are available regarding beyond-total mesorectal excision (bTME) procedure. Aim of the study is to identify patient-related and surgery-related factors influencing the 30-day readmissions after bTME. Retrospective data were collected from 220 patients who underwent bTME procedures at single centre between 2006 and 2016. Patient-related and operative factors were assessed, including body mass index (BMI), age, gender, American Society of Anaesthesiologists’ (ASA) score, preoperative stage, neo-adjuvant therapy, primary tumour vs recurrence, the extent of surgery. The readmission rate was 8.18%. No statistically significant association was found with BMI, ASA score, length of stay and stay in the intensive care unit, primary vs recurrent tumour or blood transfusions. Not quite statistically significant was the association with pelvic side wall dissection (OR 3.32, p = 0.054). Statistically significant factors included preoperative stage > IIIb (OR: 4.77, p = 0.002), neo-adjuvant therapy (OR: 0.13, p = 0.0006), age over 65 years (OR: 5.96, p = 0.0005), any re-intervention during the first admission (OR: 7.4, p = 0.0001), and any post-operative complication (OR: 9.01, p = 0.004). The readmission rate after beyond-TME procedure is influenced by patient-related factors as well as post-operative morbidity. Electronic supplementary material The online version of this article (10.1007/s13304-019-00669-6) contains supplementary material, which is available to authorized users.

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Making an IMPACT: A priority setting consultation exercise to improve outcomes in patients with locally advanced, recurrent and metastatic colorectal cancer

Cited by 17 publications

References 15 publications

Pancreaticoduodenectomy with right hemicolectomy for advanced malignancy: a single UK hepatopancreaticobiliary centre experience

Pancreaticoduodenectomy with right hemicolectomy for advanced malignancy: a single UK hepatopancreaticobiliary centre experience

A phase III randomized trial evaluating chemotherapy followed by pelvic reirradiation versus chemotherapy alone as preoperative treatment for locally recurrent rectal cancer – GRECCAR 15 trial protocol

Predictors of short-term readmission after beyond total mesorectal excision for primary locally advanced and recurrent rectal cancer

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