Modern Multidisciplinary Perioperative Management of Rectal Cancer

Berho, Mariana; Narang, Rahul; Koughnett, Julie Ann M. Van; Wexner, Steven D.

doi:10.1001/jamasurg.2014.2887

Cited by 24 publications

(20 citation statements)

References 75 publications

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“…5,25 MDC enables assessment by multiple disciplines, with subsequent provision of specialty-specific input, enhances the likelihood of delivering optimal curative therapy 26 , adds an additional layer of checks and balances in the decision-making process to minimize errors in judgment, and maximizes the probability of adopting treatment strategies that are based on the highest levels of evidence. 27 Data from oncologic literature in other cancer types 6,8,9 support improved survival outcomes in patients who receive care via multidisciplinary team approaches, and this may also be the case for patients with BC. Despite the purported benefits of MDC in oncology, its uptake in BC has been slow and may be responsible for some degree of undertreatment of many patients with MIBC.…”

Section: Discussionmentioning

confidence: 98%

“…5 Multidisciplinary care (MDC) models have been shown to maximize outcomes by minimizing such variability, which reduces judgment errors and optimizes communication among physicians and between caregivers and patients. [6][7][8][9] MDC provides an opportunity for all treatment options to be discussed, which is important for BC care, in which multiple treatment options are available to patients regardless of the stage at presentation.…”

Section: Introductionmentioning

confidence: 99%

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Propensity Score Analysis of Radical Cystectomy Versus Bladder-Sparing Trimodal Therapy in the Setting of a Multidisciplinary Bladder Cancer Clinic

Kulkarni

Hermanns

Wei

et al. 2017

JCO

266

134

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Purpose Multidisciplinary management improves complex treatment decision making in cancer care, but its impact for bladder cancer (BC) has not been documented. Although radical cystectomy (RC) currently is viewed as the standard of care for muscle-invasive bladder cancer (MIBC), radiotherapybased, bladder-sparing trimodal therapy (TMT) that combines transurethral resection of bladder tumor, chemotherapy for radiation sensitization, and external beam radiotherapy has emerged as a valid treatment option. In the absence of randomized studies, this study compared the oncologic outcomes between patients treated with RC or TMT by using a propensity score matched-cohort analysis. Methods Data from patients treated in a multidisciplinary bladder cancer clinic (MDBCC) from 2008 to 2013 were reviewed retrospectively. Those who received TMT for MIBC were identified and matched (for sex, cT and cN stage, Eastern Cooperative Oncology Group status, Charlson comorbidity score, treatment date, age, carcinoma in situ status, and hydronephrosis) with propensity scores to patients who underwent RC. Overall survival and disease-specific survival (DSS) were assessed with Cox proportional hazards modeling and a competing risk analysis, respectively. Results A total of 112 patients with MIBC were included after matching (56 who had been treated with TMT, and 56 who underwent RC). The median age was 68.0 years, and 29.5% had stage cT3/cT4 disease. At a median follow-up of 4.51 years, there were 20 deaths (35.7%) in the RC group (13 as a result of BC) and 22 deaths (39.3%) in the TMT group (13 as a result of BC). The 5-year DSS rate was 73.2% and 76.6% in the RC and TMT groups, respectively ( P = .49). Salvage cystectomy was performed in 6 (10.7%) of 56 patients who received TMT. Conclusion In the setting of a MDBCC, TMT yielded survival outcomes similar to those of matched patients who underwent RC. Appropriately selected patients with MIBC should be offered the opportunity to discuss various treatment options, including organ-sparing TMT. PurposeMultidisciplinary management improves complex treatment decision making in cancer care, but its impact for bladder cancer (BC) has not been documented. Although radical cystectomy (RC) currently is viewed as the standard of care for muscle-invasive bladder cancer (MIBC), radiotherapybased, bladder-sparing trimodal therapy (TMT) that combines transurethral resection of bladder tumor, chemotherapy for radiation sensitization, and external beam radiotherapy has emerged as a valid treatment option. In the absence of randomized studies, this study compared the oncologic outcomes between patients treated with RC or TMT by using a propensity score matched-cohort analysis. MethodsData from patients treated in a multidisciplinary bladder cancer clinic (MDBCC) from 2008 to 2013 were reviewed retrospectively. Those who received TMT for MIBC were identified and matched (for sex, cT and cN stage, Eastern Cooperative Oncology Group status, Charlson comorbidity score, treatment date, age, carcinom...

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Propensity Score Analysis of Radical Cystectomy Versus Bladder-Sparing Trimodal Therapy in the Setting of a Multidisciplinary Bladder Cancer Clinic

Kulkarni

Hermanns

Wei

et al. 2017

JCO

266

134

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“…Neoadjuvant treatment based on exclusive radiotherapy or chemoradiotherapy followed by surgical resection is the current practice in locally advanced rectal cancer (T3 or T4 tumors, with or without lymph nodes metastasis) [15]. Lymph node status is recently the powerful indicator factor for prognosis in posttherapeutic rectal cancer [8,16].…”

Section: Discussionmentioning

confidence: 99%

“…Lymph node status is recently the powerful indicator factor for prognosis in posttherapeutic rectal cancer [8,16]. General guidelines recommend the evaluation of a number of 12 regional LNs to validate an accurate ypN0 status [4,14,15]. Unfortunately, until today, there are no particular recommendations focusing on the histologic response on retrieved LNs in rectal cancer after neoadjuvant treatment.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Lymph Nodes’ Histologic Response on Survival Outcomes in Moroccan Patients with Rectal Cancer

Otmani

Agy

Abkari

et al. 2020

International Journal of Surgical Oncology

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Prognosis for patients with locally advanced rectal cancer remains controversial. The purpose of this study was to elucidate possible association between therapeutic effect on lymph nodes (LNs) and patient prognosis. Overall, 149 patients with rectal cancer received preoperative radiotherapy in concomitance with chemotherapy or exclusive radiotherapy before rectal excision. Microscopic examination of formalin-fixed lymph nodes was assessed for therapeutic effect. The establishment of groups combined reaction tissue types of fibrosis, colloid, and necrosis after neoadjuvant treatment was assigned. The average age was 56.38 years, ranged between 22 and 88 years, 53% were female, and 47% were men, with a sex ratio of 1 : 12. In the present study, we noticed that after a median follow-up time of 40.67 months (0–83; SD: 21.1), overall survival was statistically significant depending on age groups. Kaplan–Meier analysis showed significant differences in the rate of patients with an age under 65 years (70.64%) versus those with an age over 85 years (36.5%) (p<0.001). Also, the OS was statistically significant depending on therapeutic effect groups composed of 0TE (No Therapeutic effect), C+ (presence of only colloidal effect), F+ (presence of only fibrosis tissue), and ME+ (mixture of 2 or 3 types of therapeutic effect) group. Indeed, we observed a significantly higher OS rate in the ME + group (86%) compared with the OS rate of LNs group with no therapeutic effect (57%) (p=0.028). Additionally, there was a significant association between the presence of fibrosis on LNs and an extended delay of more than 8 weeks to neoadjuvant treatment completion and surgery. Our study indicates that the best patient prognosis could be predicted based on tumor presenting a best pathologic effect on lymph nodes, and that delaying surgery for more than 8 weeks to neoadjuvant treatment completion improves therapeutic response on LNs.

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“…Colorectal cancer is the third most commonly diagnosed cancer in men and the second in women [1]. In recent years, rectal cancer has developed into a comprehensive treatment mode mainly based on surgery, supplemented by radiotherapy and chemotherapy [2,3]. Laparoscopic rectal cancer surgery has been proven to have the same clinical results as traditional open surgery in terms of safety and e cacy [4,5].…”

Section: Introductionmentioning

confidence: 99%

Long-term oncologic outcomes of laparoscopic low anterior resection of rectal cancer with preservation of the left colic artery

Luo¹,

Li²,

Wu³

et al. 2020

Preprint

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Aim To analyze the effect of preserving the left colic artery (LCA) on long-term oncologic outcomes during laparoscopic low anterior resection of rectal cancer. Methods Clinicopathological and follow-up patients undergoing laparoscopic low anterior resection of rectal cancer in general surgery department of Guangdong Provincial People's Hospital from January 2014 to December 2015 were retrospectively collected. According to the difference surgical methods of inferior mesenteric artery (IMA), 159 cases were divided into the LCA preservation group and 225 cases in the LCA non-preservation group. The 5-year rates of overall survival (OS) and disease-free survival (DFS) were compared between two group. Results 384 patients were included in final analysis. Anastomotic leakage occurred in 7 patients (4.4%) in the LCA preservation group and in 16 patients (7.1%) in the LCA non-preservation group. The follow-up rate was 91.2% (145/159) during 5–60 months in LCA preservation group, and 89.8% (202/225) during 5–60 months in the LCA non-preservation group. The number of patients who developed death, local recurrence and metastasis were 59 (37.1%), 13 (8.2%) and 60 (37.7%) in the LCA preservation group, and 86 (38.2%), 20 (8.9%) and 92 (40.9%) in the LCA non-preservation group, without significant differences (all P ༞ 0.05). The 5-year OS and DFS rates were 69.0% and 59.3% in the LCA preservation group, and 68.8% and 55.9% in the LCA non-preservation group, without significant differences (all P ༞ 0.05). After stratification by TNM Stage, the difference on 5-year OS rates and DFS rates of I stage, II stage and III stage in two groups were no significant as well (all P ༞ 0.05). Conclusions The long-term oncologic outcomes of laparoscopic low anterior resection of rectal cancer with preservation of the LCA are comparable with ligation at origin of IMA.

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Modern Multidisciplinary Perioperative Management of Rectal Cancer

Abstract: Many new technologies and treatment options will continue to advance the treatment of rectal cancer, further emphasizing the need for a multidisciplinary approach to achieve optimal care.

Cited by 24 publications

References 75 publications

Propensity Score Analysis of Radical Cystectomy Versus Bladder-Sparing Trimodal Therapy in the Setting of a Multidisciplinary Bladder Cancer Clinic

Propensity Score Analysis of Radical Cystectomy Versus Bladder-Sparing Trimodal Therapy in the Setting of a Multidisciplinary Bladder Cancer Clinic

The Effect of Lymph Nodes’ Histologic Response on Survival Outcomes in Moroccan Patients with Rectal Cancer

Long-term oncologic outcomes of laparoscopic low anterior resection of rectal cancer with preservation of the left colic artery

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