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

Abstract

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 using. 2 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