Clin Colon Rectal Surg 2007; 20(3): 143-147
DOI: 10.1055/s-2007-984858
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Multidisciplinary Teams in the Management of Rectal Cancer

Vincent J. Obias1 , Harry L. Reynolds1  Jr. 
  • 1Section of Colorectal Cancer Surgery, Case Western Reserve University, University Hospitals of Cleveland Case Medical Center, Cleveland, Ohio
Further Information

Publication History

Publication Date:
31 July 2007 (online)

ABSTRACT

A myriad of advances in the treatment of rectal cancer have been achieved over the last few decades. The introduction of total mesorectal excision (TME) has resulted in significant improvements in local recurrence. Surgical education on the technique has made it the standard of care. Radiation and chemotherapy combined with TME have improved results even further with stage II and III cancers. Sphincter-sparing techniques, reservoir procedures, local treatment advances, minimally invasive techniques, surgery for metastatic disease, newer chemotherapies, and extended resections for locally advanced and recurrent lesions, have all benefited the patient with rectal cancer. The goal and responsibility of colorectal surgeons treating rectal cancer patients is to understand and coordinate the wide variety of modalities available to optimize survival, minimize morbidity, and maximize quality of life for those with this difficult problem. Coordination of specialists in this time of evolution in rectal cancer treatment becomes more important than ever. Here the authors briefly review the role of the multidisciplinary team, discuss a model multidisciplinary team approach and look at evidence supporting team use as we begin this issue devoted to the multidisciplinary management of rectal cancer.

REFERENCES

  • 1 Birgisson H, Talback M, Gunnarsson U, Pahlman L, Glimelius B. Improved survival of cancer of the colon in rectum in Sweden.  Eur J Surg Oncol. 2005;  31(8) 845-853
  • 2 Heald R J, Moran B, Ryall R D, Sexton R, MacFarlane J K. Rectal cancer: The Basingstoke experience of total mesorectal excision, 1978-1997.  Arch Surg. 1998;  133 894-899
  • 3 Kapiteijn E, Putter H, van de Velde C J. Cooperative Investigators of the Dutch Colorectal Cancer Group . Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands.  Br J Surg. 2002;  89 1142-1149
  • 4 Law W L, Chu K W. Impact of total mesorectal excision on the results of surgery of distal rectal cancer.  Br J Surg. 2001;  88 1607-1612
  • 5 Martling A L, Holm T, Rutqvist L E, Moran B J, Heald R J, Cedemark B. Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group. Basingstoke Bowel Cancer Research Project.  Lancet. 2000;  356 93-96
  • 6 Sauer R, Fietkau R, Wittekind C et al.. Adjuvant vs. neoadjuvant radiochemotherapy for locally advanced rectal cancer: the German trial CAO/ARO/AIO-94.  Colorectal Dis. 2003;  5 406-415
  • 7 Swedish Rectal Cancer Trial . Improved survival with preoperative radiation in rectable rectal cancer.  N Engl J Med. 1997;  336 980-987
  • 8 National Institute for Clinical Excellence .Improving Outcomes in Colorectal Cancers: Manual Update. London, UK; National Institute for Clinical Excellence 2004
  • 9 Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun M J. Cancer statistics, 2007.  CA Cancer J Clin. 2007;  57 43-66
  • 10 Bailey H R, Huval W V, Max E, Smith K W, Butts D R, Zamora L F. Local excision of carcinoma of rectum for cure.  Surgery. 1992;  111 555-561
  • 11 Taylor R H, Hay J H, Larsson S N. Transanal local excision of selected low rectal cancers.  Am J Surg. 1998;  175(5) 360-363
  • 12 Konishi F, Muto T, Takahashi H, Itoh K, Kanazawa K, Morioka Y. Transrectal ultrasonography for the assessment of invasion of rectal carcinoma.  Dis Colon Rectum. 1985;  28 889-894
  • 13 Orrom W J, Wong W D, Rothenberger D A, Jensen L L, Goldberg S M. Endorectal ultrasound in preoperative staging of rectal tumors.  Dis Colon Rectum. 1990;  33 654-659
  • 14 Beynon J, Mortenssen N J, Foy D M, Channer J L, Virjee G P. Pre-operative assessment of local invasion in rectal cancer: digital examination, endoluminal sonography, or computed tomography?.  Br J Surg. 1986;  73 1015-1017
  • 15 Romano G, de Rosa P, Vallone G, Rotondo A, Grassi R, Santangelo M L. Intrarectal ultrasound and computed tomography in the pre- and postoperative assessment of patients with rectal cancer.  Br J Surg. 1985;  72 s117-s119
  • 16 Milsom J W, Lavery I C, Stolfi V M et al.. The expanding utility of endoluminal ultrasonography in the management of rectal cancer.  Surgery. 1992;  112 832-840
  • 17 Beynon J, Mortensen N J, Foy D M, Channer J L, Rigby H, Virjee J. Preoperative assessment of mesorectal lymph node involvement in rectal cancer.  Br J Surg. 1989;  76 276-279
  • 18 Mathur P, Smith J J, Ramsey C et al.. Comparison of CT and MRI in the pre-operative staging of rectal adenocarcinoma and prediction of circumferential resection margin involvement by MRI.  Colorectal Dis. 2003;  5 396-401
  • 19 Martling A, Holm T, Bremmer S, Lindholm J, Cedermark B, Blomqvist L. Prognostic value of preoperative magnetic resonance imaging of the pelvis in rectal cancer.  Br J Surg. 2003;  90 1422-1428
  • 20 Beets-Tan R G, Beets G L, Vliegen R F et al.. Accuracy of magnetic resonance imagine in predicting tumour-free resection margin in rectal cancer surgery.  Lancet. 2001;  357 497-504
  • 21 Kim N K, Kim M J, Park J K, Park S I, Min J S. Preoperative staging of rectal cancer with MRI: accuracy and clinical usefulness.  Ann Surg Oncol. 2000;  7(10) 732-737
  • 22 Guinet C, Buy J N, Ghossain M A et al.. Comparison of magnetic resonance imaging and computed tomography in the preoperative staging of rectal cancer.  Arch Surg. 1990;  125 385-388
  • 23 Waizer A, Zitron S, Ben-Baruch D, Baniel J, Wolloch Y, Dintsman M. Comparative study for preoperative staging of rectal cancer.  Dis Colon Rectum. 1989;  32(1) 53-56
  • 24 Sauer R, Becker H, Hohenberger W et al.. Preoperative versus postoperative chemoradiotherapy for rectal cancer.  N Engl J Med. 2004;  351(17) 1731-1740
  • 25 Kapiteijn E, Marijnen C A, Nagtegaal I D et al.. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer.  N Engl J Med. 2001;  345(9) 638-646
  • 26 Moore H G, Riedel E, Minsky B D et al.. Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapy.  Ann Surg Oncol. 2003;  10(1) 80-85
  • 27 Hall N R, Finan P J, Al-Jaberi T et al.. Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent: predictor of survival but not local recurrence?.  Dis Colon Rectum. 1998;  41(8) 979-983
  • 28 Adam I J, Mohamdee M O, Martin I G et al.. Role of circumferential resection margin involvement in the local recurrence of rectal cancer.  Lancet. 1994;  344(8924) 707-711
  • 29 Quirke P, Durdey P, Dixon M F, Williams N S. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision.  Lancet. 1986;  2(8514) 996-999
  • 30 Madbouly K M, Remzi F H, Erkek B A et al.. Recurrence after transanal excision of T1 rectal cancer: Should we be concerned?.  Dis Colon Rectum. 2005;  48(4) 711-721
  • 31 Ota D M, Nelson H. Local excision of rectal cancer revisited: ACOSOG Protocol Z6041.  Ann Surg Oncol. 2007;  14(2) 271
  • 32 Mellgren A, Sirivongs P, Rothenberger D A, Madoff R D, Garcia-Aguilar J. Is local excision adequate therapy for early rectal cancer?.  Dis Colon Rectum. 2000;  43(8) 1064-1074
  • 33 Garcia-Aguilar J, Mellgren A, Sirivongs P, Buie D, Madoff R D, Rothenberger D A. Local excision of rectal cancer without adjuvant therapy: a word of caution.  Ann Surg. 2000;  231(3) 345-351
  • 34 Habr-Gama A, Perez R O, Nadalin W et al.. Operative versus nonoperative treatment for Stage 0 distal rectal cancer following chemoradiation therapy: Long-term results.  Ann Surg. 2004;  240(4) 711-718
  • 35 Marks G, Mohiuddin M M, Masoni L, Pecchioli L. High-dose preoperative radiation and full-thickness local excision. A new option for patients with select cancers of the rectum.  Dis Colon Rectum. 1990;  33(9) 735-739
  • 36 Jessop J, Daniels I. The role of the multidisciplinary team in the management of colorectal cancer. In: Scholefield JH, Abcarian H, Maughan T Challenges in Colorectal Cancer. 2nd ed. Oxford; Blackwell 2006: 167-177
  • 37 Rogers Jr S O, Wolf R E, Zaslavsky A M, Wright W E, Avanian J Z. Relation of surgeon and hospital volume to processes and outcomes of colorectal cancer surgery.  Ann Surg. 2006;  244(6) 1003-1011
  • 38 McGrath D R, Leong D C, Gibberd R, Armstrong B, Spigelman A D. Surgeon and hospital volume and the management of colorectal cancer patients in Australia.  ANZ J Surg. 2005;  75(10) 901-910
  • 39 Purves H, Pietrobon R, Hervey S, Guller U, Miller W, Ludwig K. Relationship between surgeon caseload and sphincter preservation in patients with rectal cancer.  Dis Colon Rectum. 2005;  48(2) 195-204
  • 40 McArdle C S, Hole D J. Influence of volume and specialization on survival following surgery for colorectal cancer.  Br J Surg. 2004;  91(5) 610-617
  • 41 Morris E, Howard R A, Gilthorpe M S, Craigs C, Forman D. The impact of the Calman-Hine report on the processes and outcomes of care for Yorkshire's colorectal cancer patients.  Br J Cancer. 2006;  95(8) 979-985

Harry L Reynolds Jr.M.D. 

Section of Colorectal Cancer Surgery, Case Western Reserve University, University Hospitals of Cleveland Case Medical Center

11100 Euclid Ave., Cleveland, OH 44106

Email: harry.reynolds@uhhospitals.org

    >