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Open Access 01-11-2010

International Preoperative Rectal Cancer Management: Staging, Neoadjuvant Treatment, and Impact of Multidisciplinary Teams

Authors: Knut M. Augestad, Rolv-Ole Lindsetmo, Jonah Stulberg, Harry Reynolds, Anthony Senagore, Brad Champagne, Alexander G. Heriot, Fabien Leblanc, Conor P. Delaney, International Rectal Cancer Study Group (IRCSG)

Published in: World Journal of Surgery | Issue 11/2010

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. Seventy-four 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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Title: International Preoperative Rectal Cancer Management: Staging, Neoadjuvant Treatment, and Impact of Multidisciplinary Teams
Authors: Knut M. Augestad
Rolv-Ole Lindsetmo
Jonah Stulberg
Harry Reynolds
Anthony Senagore
Brad Champagne
Alexander G. Heriot
Fabien Leblanc
Conor P. Delaney
International Rectal Cancer Study Group (IRCSG)
Publication date: 01-11-2010
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 11/2010
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-010-0738-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

International Preoperative Rectal Cancer Management: Staging, Neoadjuvant Treatment, and Impact of Multidisciplinary Teams

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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