Changes in the multidisciplinary management of rectal cancer from 2009 to 2015 and associated improvements in short‐term outcomes

Roxburgh, C.S.D. et al. (2019) Changes in the multidisciplinary management of rectal cancer from 2009 to 2015 and associated improvements in short‐term outcomes. Colorectal Disease, 21(10), pp. 1140-1150. (doi: 10.1111/codi.14713) (PMID:31108012) (PMCID:PMC6773478)

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Aim: Significant recent changes in management of locally advanced rectal cancer include preoperative staging, use of extended neoadjuvant therapies, and minimally invasive surgery (MIS). This study was aimed at characterizing those changes and associated short‐term outcomes. Method: We retrospectively analysed treatment and outcome data from patients with T3/4 or N+ locally advanced rectal cancer ≤15 cm from the anal verge who were evaluated at a comprehensive cancer center in 2009–2015. Results: In total, 798 patients were identified and grouped into five cohorts based on treatment year: 2009‐2010, 2011, 2012, 2013, and 2014‐2015. Temporal changes included increased reliance on MRI staging, from 57% in 2009‐2010 to 98% in 2014‐2015 (p < 0.001); increased use of total neoadjuvant therapy, from 17% to 76% (p < 0.001); and increased use of MIS, from 33% to 70% (p < 0.001). Concurrently, median hospital stay decreased (from 7 to 5 days; p < 0.001), as did the rates of grade III‐V complications (from 13% to 7%; p < 0.05), surgical site infections (from 24% to 8%; p < 0.001), anastomotic leak (from 11% to 3%; p < 0.05), and positive circumferential resection margin (from 9% to 4%; p < 0.05). TNM downstaging increased from 62% to 74% (p = 0.002). Conclusion: Shifts toward MRI‐based staging, total neoadjuvant therapy, and MIS occurred between 2009 and 2015. Over the same period, treatment responses improved, and lengths of stay and the incidence of complications decreased.

Item Type:Articles
Additional Information:NCI grant P30 CA008748.
Glasgow Author(s) Enlighten ID:Roxburgh, Professor Campbell
Authors: Roxburgh, C.S.D., Strombom, P., Lynn, P., Cercek, A., Gonen, M., Smith, J., Temple, L.K.F., Nash, G.M., Guillem, J.G., Paty, P.B., Shia, J., Vakiani, E., Yaeger, R., Stadler, Z.K., Segal, N.H., Reidy, D., Varghese, A., Wu, A.J., Crane, C.H., Gollub, M.J., Saltz, L.B., Garcia‐Aguilar, J., and Weiser, M.R.
College/School:College of Medical Veterinary and Life Sciences > School of Cancer Sciences
Journal Name:Colorectal Disease
ISSN (Online):1463-1318
Published Online:20 May 2019
Copyright Holders:Copyright © 2019 The Association of Coloproctology of Great Britain and Ireland
First Published:First published in Colorectal Disease 21(10):1140-1150
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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