Value of multi-disciplinary input into laparoscopic management of rectal cancer-An observational stu

来源 :World Journal of Gastrointestinal Surgery | 被引量 : 0次 | 上传用户:yingxiong324
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AIM To assess the impact of multi-disciplinary teams(MDTs)management in optimising the outcome for rectal cancers.METHODS We undertook a retrospective review of a prospectively maintained database of patients with rectal cancers(defined as tumours≤15 cm from anal verge)discussed at our MDT between Jan 2008 and Jan 2011.The data was validated against the national database to ensure completeness of dataset.The clinical course and follow-up data was validated using the institution’s electronic patient records.The data was analysed in terms of frequencies and percentages.Significance of any differences were analysed usingχ2 test.A Kaplan-Meier analysis was performed for overall survival and disease free survival.RESULTS Following appropriate staging,one hundred and thirtythree patients were suitable for potentially curative resections.Seventy two(54%)were upper rectal cancer(URC)-tumour was>6 cm from the anal verge and 61(46%)were lower rectal cancers(LRC)-lower extent of the tumour was palpable≤6 cm.Circumferential resection margin(CRM)appeared threatened on preoperative MRI in 19/61(31%)patients with LRC requiring neo-adjuvant therapy(NAT).Of the 133 resections,118(89%)were attempted laparoscopically(5%conversion rate).CRM was positive in 9(6.7%)patients;Median lymph node harvest was 12(2-37).Major complications occurred in 8(6%)patients.Median follow-up was 53 mo(0-82).The 90-d mortality was 2(1.5%).Over the followup period,disease related mortality was 11(8.2%)and overall mortality was 39(29.3%).Four(3%)patients had local recurrence and 22(16.5%)patients had distant metastases.CONCLUSION Management of rectal cancers can be optimized with multidisciplinary input to attain acceptable long-term oncological outcomes even when incorporating a laparoscopic approach to rectal cancer resection. AIM To assess the impact of multi-disciplinary teams (MDTs) management in optimizing the outcome for rectal cancers. METHODS We undertook a retrospective review of a prospectively maintained database of patients with rectal cancers (defined as tumours≤15 cm from anal verge) at our MDT between Jan 2008 and Jan 2011.The data was validated against the national database to ensure completeness of dataset.The clinical course and follow-up data was validated using the institution’s electronic patient records. The data was analyzed in terms of frequencies and percentages.Significance of any differences were analysed usingχ2 test. A Kaplan-Meier analysis was performed for overall survival and disease free survival. One hundred and thirtythree patients were suitable for potentially curative resections. Seventy two (54%) were upper rectal cancer (URC) -tumor was> 6 cm from the anal verge and 61 (46%) were lower rectal cancers (LRC) -lower extent of the tumor w as palpable ≤ 6 cm. Circulation of preoperative MRI in 19/61 (31%) patients with LRC requiring neo-adjuvant therapy (NAT) .Of the 133 resections, 118 (89%) were attempted laparoscopically Median lymph node harvest was 12 (2-37). Maior onset occurred in 8 (6%) patients. Median follow-up was 53 mo (0% -82). The 90-d mortality was 2 (1.5%). Over the followup period, the disease related mortality was 11 (8.2%) and the overall mortality was 39 22 (16.5%) patients had distant metastases. CONCLUSION Management of rectal cancers can be optimized with multidisciplinary input to attain acceptable long-term oncological outcomes even when incorporating a laparoscopic approach to rectal cancer resection.
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