International preoperative rectal cancer management

Staging, neoadjuvant treatment, and impact of multidisciplinary teams

Knut M. Augestad, Rolv Ole Lindsetmo, Jonah Stulberg, Harry Reynolds, Anthony Senagore, Brad Champagne, Alexander G. Heriot, Fabien Leblanc, Conor P. Delaney

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Background Little is known regarding variations in preoperative treatment and practice for rectal cancer (RC) on an international level, yet practice variation may result in differences in recurrence and survival rates. Methods One hundred seventy-three international colorectal centers were invited to participate in a survey of preoperative management of rectal cancer. Results One hundred twenty-three (71%) responded, with a majority of respondents from North America, Europe, and Asia. Ninety-three percent have more than 5 years' experience with rectal cancer surgery. Fifty-five percent use CT scan, 35% MRI, 29% ERUS, 12% digital rectal examination and 1% PET scan in all RC cases. Seventyfour percent consider threatened circumferential margin (CRM) an indication for neoadjuvant treatment. Ninety-two percent prefer 5-FU-based long-course neoadjuvant chemoradiation therapy (CRT). A significant difference in practice exists between the US and non-US surgeons: poor histological differentiation as an indication for CRT (25% vs. 7.0%, p = 0.008), CRT for stage II and III rectal cancer (92% vs. 43%, p = 0.0001), MRI for all RC patients (20% vs. 42%, p = 0.03), and ERUS for all RC patients (43% vs. 21%, p = 0.01). Multidisciplinary team meetings significantly influence decisions for MRI (RR = 3.62), neoadjuvant treatment (threatened CRM, RR = 5.67, stage II III RR = 2.98), quality of pathology report (RR = 4.85), and sphincter-saving surgery (RR = 3.81). Conclusions There was little consensus on staging, neoadjuvant treatment, and preoperative management of rectal cancer. Regular multidisciplinary team meetings influence decisions about neoadjuvant treatment and staging methods.

Original languageEnglish (US)
Pages (from-to)2689-2700
Number of pages12
JournalWorld Journal of Surgery
Volume34
Issue number11
DOIs
StatePublished - 2010
Externally publishedYes

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Neoadjuvant Therapy
Neoplasm Staging
Rectal Neoplasms
Northern Asia
Digital Rectal Examination
North America
Fluorouracil
Positron-Emission Tomography
Therapeutics
Survival Rate
Magnetic Resonance Imaging
Pathology
Recurrence

ASJC Scopus subject areas

  • Surgery

Cite this

Augestad, K. M., Lindsetmo, R. O., Stulberg, J., Reynolds, H., Senagore, A., Champagne, B., ... Delaney, C. P. (2010). International preoperative rectal cancer management: Staging, neoadjuvant treatment, and impact of multidisciplinary teams. World Journal of Surgery, 34(11), 2689-2700. https://doi.org/10.1007/s00268-010-0738-3

International preoperative rectal cancer management : Staging, neoadjuvant treatment, and impact of multidisciplinary teams. / Augestad, Knut M.; Lindsetmo, Rolv Ole; Stulberg, Jonah; Reynolds, Harry; Senagore, Anthony; Champagne, Brad; Heriot, Alexander G.; Leblanc, Fabien; Delaney, Conor P.

In: World Journal of Surgery, Vol. 34, No. 11, 2010, p. 2689-2700.

Research output: Contribution to journalArticle

Augestad, KM, Lindsetmo, RO, Stulberg, J, Reynolds, H, Senagore, A, Champagne, B, Heriot, AG, Leblanc, F & Delaney, CP 2010, 'International preoperative rectal cancer management: Staging, neoadjuvant treatment, and impact of multidisciplinary teams', World Journal of Surgery, vol. 34, no. 11, pp. 2689-2700. https://doi.org/10.1007/s00268-010-0738-3
Augestad, Knut M. ; Lindsetmo, Rolv Ole ; Stulberg, Jonah ; Reynolds, Harry ; Senagore, Anthony ; Champagne, Brad ; Heriot, Alexander G. ; Leblanc, Fabien ; Delaney, Conor P. / International preoperative rectal cancer management : Staging, neoadjuvant treatment, and impact of multidisciplinary teams. In: World Journal of Surgery. 2010 ; Vol. 34, No. 11. pp. 2689-2700.
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abstract = "Background Little is known regarding variations in preoperative treatment and practice for rectal cancer (RC) on an international level, yet practice variation may result in differences in recurrence and survival rates. Methods One hundred seventy-three international colorectal centers were invited to participate in a survey of preoperative management of rectal cancer. Results One hundred twenty-three (71{\%}) responded, with a majority of respondents from North America, Europe, and Asia. Ninety-three percent have more than 5 years' experience with rectal cancer surgery. Fifty-five percent use CT scan, 35{\%} MRI, 29{\%} ERUS, 12{\%} digital rectal examination and 1{\%} PET scan in all RC cases. Seventyfour percent consider threatened circumferential margin (CRM) an indication for neoadjuvant treatment. Ninety-two percent prefer 5-FU-based long-course neoadjuvant chemoradiation therapy (CRT). A significant difference in practice exists between the US and non-US surgeons: poor histological differentiation as an indication for CRT (25{\%} vs. 7.0{\%}, p = 0.008), CRT for stage II and III rectal cancer (92{\%} vs. 43{\%}, p = 0.0001), MRI for all RC patients (20{\%} vs. 42{\%}, p = 0.03), and ERUS for all RC patients (43{\%} vs. 21{\%}, p = 0.01). Multidisciplinary team meetings significantly influence decisions for MRI (RR = 3.62), neoadjuvant treatment (threatened CRM, RR = 5.67, stage II III RR = 2.98), quality of pathology report (RR = 4.85), and sphincter-saving surgery (RR = 3.81). Conclusions There was little consensus on staging, neoadjuvant treatment, and preoperative management of rectal cancer. Regular multidisciplinary team meetings influence decisions about neoadjuvant treatment and staging methods.",
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T1 - International preoperative rectal cancer management

T2 - Staging, neoadjuvant treatment, and impact of multidisciplinary teams

AU - Augestad, Knut M.

AU - Lindsetmo, Rolv Ole

AU - Stulberg, Jonah

AU - Reynolds, Harry

AU - Senagore, Anthony

AU - Champagne, Brad

AU - Heriot, Alexander G.

AU - Leblanc, Fabien

AU - Delaney, Conor P.

PY - 2010

Y1 - 2010

N2 - Background Little is known regarding variations in preoperative treatment and practice for rectal cancer (RC) on an international level, yet practice variation may result in differences in recurrence and survival rates. Methods One hundred seventy-three international colorectal centers were invited to participate in a survey of preoperative management of rectal cancer. Results One hundred twenty-three (71%) responded, with a majority of respondents from North America, Europe, and Asia. Ninety-three percent have more than 5 years' experience with rectal cancer surgery. Fifty-five percent use CT scan, 35% MRI, 29% ERUS, 12% digital rectal examination and 1% PET scan in all RC cases. Seventyfour percent consider threatened circumferential margin (CRM) an indication for neoadjuvant treatment. Ninety-two percent prefer 5-FU-based long-course neoadjuvant chemoradiation therapy (CRT). A significant difference in practice exists between the US and non-US surgeons: poor histological differentiation as an indication for CRT (25% vs. 7.0%, p = 0.008), CRT for stage II and III rectal cancer (92% vs. 43%, p = 0.0001), MRI for all RC patients (20% vs. 42%, p = 0.03), and ERUS for all RC patients (43% vs. 21%, p = 0.01). Multidisciplinary team meetings significantly influence decisions for MRI (RR = 3.62), neoadjuvant treatment (threatened CRM, RR = 5.67, stage II III RR = 2.98), quality of pathology report (RR = 4.85), and sphincter-saving surgery (RR = 3.81). Conclusions There was little consensus on staging, neoadjuvant treatment, and preoperative management of rectal cancer. Regular multidisciplinary team meetings influence decisions about neoadjuvant treatment and staging methods.

AB - Background Little is known regarding variations in preoperative treatment and practice for rectal cancer (RC) on an international level, yet practice variation may result in differences in recurrence and survival rates. Methods One hundred seventy-three international colorectal centers were invited to participate in a survey of preoperative management of rectal cancer. Results One hundred twenty-three (71%) responded, with a majority of respondents from North America, Europe, and Asia. Ninety-three percent have more than 5 years' experience with rectal cancer surgery. Fifty-five percent use CT scan, 35% MRI, 29% ERUS, 12% digital rectal examination and 1% PET scan in all RC cases. Seventyfour percent consider threatened circumferential margin (CRM) an indication for neoadjuvant treatment. Ninety-two percent prefer 5-FU-based long-course neoadjuvant chemoradiation therapy (CRT). A significant difference in practice exists between the US and non-US surgeons: poor histological differentiation as an indication for CRT (25% vs. 7.0%, p = 0.008), CRT for stage II and III rectal cancer (92% vs. 43%, p = 0.0001), MRI for all RC patients (20% vs. 42%, p = 0.03), and ERUS for all RC patients (43% vs. 21%, p = 0.01). Multidisciplinary team meetings significantly influence decisions for MRI (RR = 3.62), neoadjuvant treatment (threatened CRM, RR = 5.67, stage II III RR = 2.98), quality of pathology report (RR = 4.85), and sphincter-saving surgery (RR = 3.81). Conclusions There was little consensus on staging, neoadjuvant treatment, and preoperative management of rectal cancer. Regular multidisciplinary team meetings influence decisions about neoadjuvant treatment and staging methods.

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