Management of Significant Polyp and Early Colorectal Cancer Is Optimized by Implementation of a Dedicated Multidisciplinary Team Meeting: Lessons Learned From the United Kingdom National Program

Abstract

BACKGROUND:The concept of significant polyps and early colorectal cancer encompasses complex polyps not amenable to routine snare polypectomy or where malignancy cannot be excluded. The assessment and management of these lesions is contentious and increasingly important due to the significant risk of over-or undertreatment. OBJECTIVE:Following the recommendations of the Significant Polyps and Early Colorectal Cancer National Program, we implemented a dedicated multidisciplinary team meeting and analyzed the influence on patient outcomes. DESIGN:This was a retrospective study using a prospectively collected database of patients discussed at the dedicated multidisciplinary team meeting. SETTINGS:This study was conducted in a single tertiarycare center.PATIENTS: Consecutive patients with significant polyps and early colorectal cancer were identified either through the Bowel Cancer Screening Program or colonoscopy for symptomatic patients. MAIN OUTCOME MEASURES:Proportions of patients who had organ preservation, and secondary treatment and recurrence rate served as outcome measures. RESULTS:Overall, 135 patients discussed at the dedicated multidisciplinary team meeting were included, with a median age of 71 years. Median size of the lesions was 25 mm, and 39% were in the rectum. Patients were discussed either after the lesion was removed during the initial colonoscopy (n = 38), of whom 16 (42%) had unexpected cancer, or had no initial treatment with subsequent case review (n = 97). Of these 97 patients, 46 underwent endoscopic excision (26% cancer), 20 transanal excision (10% cancer), 23 primary surgical resection (35% cancer), and 8 had no treatment. In 104 (82%) patients, organ preservation was achieved. Secondary surgery was required in 7 of 104 (6.7%) patients after local excision due to radical treatment of high-risk T1 lesions, local recurrence, or patients' decisions. The cumulative hazard estimates for recurrence after a median follow-up of 18.5 months was less than 10% for both benign and malignant lesions. LIMITATIONS:This study was limited by its relatively small sample size and single-center setting. CONCLUSIONS:A dedicated multidisciplinary team meeting improved the management of significant polyps and early colorectal cancer, safely refining organ preservation for patients, with low recurrence rates. See

Can We Do Better Than a Colectomy?

“…How do we decide which treatment modality is the most appropriate? In this issue of Diseases of the Colon & Rectum, di Fabio et al 8…”

“…How do we decide which treatment modality is the most appropriate? In this issue of Diseases of the Colon & Rectum , di Fabio et al 8 describe how a dedicated multidisciplinary team (MDT) meeting as outlined by a UK national program can improve the management of significant polyps and early colorectal cancer by avoiding bowel resection and maintaining a low recurrence rate. The MDT comprises surgeons, gastroenterologists, nurse specialists, pathologists, radiologists, and oncologists.…”