Impact of a multidisciplinary training programme on outcome of upper rectal cancer by critical appraisal of the extent of mesorectal excision with postoperative MRI

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Impact of a multidisciplinary training programme on outcome of upper rectal cancer by critical appraisal of the extent of mesorectal excision with postoperative MRI. / Bondeven, P.; Laurberg, S.; Hagemann-Madsen, R. H.; Pedersen, B. G.

I: BJS Open, Bind 4, Nr. 2, 04.2020, s. 274-283.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

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@article{9b2f510a2da24a61ae378b62a7ef7d10,
title = "Impact of a multidisciplinary training programme on outcome of upper rectal cancer by critical appraisal of the extent of mesorectal excision with postoperative MRI",
abstract = "Background Optimal management of patients with upper rectal cancer remains unclear. Partial mesorectal excision (PME) without neoadjuvant therapy is currently advocated for the majority of patients. Recent studies, however, reported a high risk of local recurrence and suboptimal surgery. The aim of this study was to evaluate the effects of a quality assurance initiative with postoperative MRI to improve outcomes in these patients. Methods Patients who underwent mesorectal excision with curative intent for rectal cancer in 2007-2013 were included. Postoperative MRI of the pelvis was performed 1 year after surgery. In 2011, a multidisciplinary workshop with focus on extent and completeness of surgery was held for training surgeons, pathologists and radiologists involved in treatment planning. Images of residual mesorectum and histopathological reports were reviewed with regard to the distal resection margin. Local recurrence after a minimum of 3 years' follow-up was compared between two cohorts from 2007-2010 and 2011-2013. Results A total of 627 patients were included; postoperative MRI of the pelvis was done in 381 patients. The 3-year actuarial local recurrence rate in patients with upper rectal cancer improved from 12 center dot 9 to 5 center dot 0 per cent (P = 0 center dot 012). After the workshop, fewer patients with cancer of the upper rectum were selected to have PME (90 center dot 8 per cent in 2007-2010 versus 80 center dot 2 per cent in 2011-2013; P = 0 center dot 023), and fewer patients who underwent PME had an insufficient distal resection margin (61 center dot 7 versus 31 per cent respectively; P <0 center dot 001). Conclusion Quality assessment of surgical practice may have a major impact on oncological outcome after surgery for upper rectal cancer.",
keywords = "QUALITY-OF-LIFE, LOCAL RECURRENCE, NEOADJUVANT THERAPY, ANTERIOR RESECTION, COLORECTAL-CANCER, BOWEL DYSFUNCTION, HIGH-RISK, POPULATION, SURGERY, TRIAL",
author = "P. Bondeven and S. Laurberg and Hagemann-Madsen, {R. H.} and Pedersen, {B. G.}",
note = "{\textcopyright} 2019 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of British Journal of Surgery Society.",
year = "2020",
month = apr,
doi = "10.1002/bjs5.50242",
language = "English",
volume = "4",
pages = "274--283",
journal = "BJS Open",
issn = "2474-9842",
publisher = "John Wiley & Sons Ltd",
number = "2",

}

RIS

TY - JOUR

T1 - Impact of a multidisciplinary training programme on outcome of upper rectal cancer by critical appraisal of the extent of mesorectal excision with postoperative MRI

AU - Bondeven, P.

AU - Laurberg, S.

AU - Hagemann-Madsen, R. H.

AU - Pedersen, B. G.

N1 - © 2019 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of British Journal of Surgery Society.

PY - 2020/4

Y1 - 2020/4

N2 - Background Optimal management of patients with upper rectal cancer remains unclear. Partial mesorectal excision (PME) without neoadjuvant therapy is currently advocated for the majority of patients. Recent studies, however, reported a high risk of local recurrence and suboptimal surgery. The aim of this study was to evaluate the effects of a quality assurance initiative with postoperative MRI to improve outcomes in these patients. Methods Patients who underwent mesorectal excision with curative intent for rectal cancer in 2007-2013 were included. Postoperative MRI of the pelvis was performed 1 year after surgery. In 2011, a multidisciplinary workshop with focus on extent and completeness of surgery was held for training surgeons, pathologists and radiologists involved in treatment planning. Images of residual mesorectum and histopathological reports were reviewed with regard to the distal resection margin. Local recurrence after a minimum of 3 years' follow-up was compared between two cohorts from 2007-2010 and 2011-2013. Results A total of 627 patients were included; postoperative MRI of the pelvis was done in 381 patients. The 3-year actuarial local recurrence rate in patients with upper rectal cancer improved from 12 center dot 9 to 5 center dot 0 per cent (P = 0 center dot 012). After the workshop, fewer patients with cancer of the upper rectum were selected to have PME (90 center dot 8 per cent in 2007-2010 versus 80 center dot 2 per cent in 2011-2013; P = 0 center dot 023), and fewer patients who underwent PME had an insufficient distal resection margin (61 center dot 7 versus 31 per cent respectively; P <0 center dot 001). Conclusion Quality assessment of surgical practice may have a major impact on oncological outcome after surgery for upper rectal cancer.

AB - Background Optimal management of patients with upper rectal cancer remains unclear. Partial mesorectal excision (PME) without neoadjuvant therapy is currently advocated for the majority of patients. Recent studies, however, reported a high risk of local recurrence and suboptimal surgery. The aim of this study was to evaluate the effects of a quality assurance initiative with postoperative MRI to improve outcomes in these patients. Methods Patients who underwent mesorectal excision with curative intent for rectal cancer in 2007-2013 were included. Postoperative MRI of the pelvis was performed 1 year after surgery. In 2011, a multidisciplinary workshop with focus on extent and completeness of surgery was held for training surgeons, pathologists and radiologists involved in treatment planning. Images of residual mesorectum and histopathological reports were reviewed with regard to the distal resection margin. Local recurrence after a minimum of 3 years' follow-up was compared between two cohorts from 2007-2010 and 2011-2013. Results A total of 627 patients were included; postoperative MRI of the pelvis was done in 381 patients. The 3-year actuarial local recurrence rate in patients with upper rectal cancer improved from 12 center dot 9 to 5 center dot 0 per cent (P = 0 center dot 012). After the workshop, fewer patients with cancer of the upper rectum were selected to have PME (90 center dot 8 per cent in 2007-2010 versus 80 center dot 2 per cent in 2011-2013; P = 0 center dot 023), and fewer patients who underwent PME had an insufficient distal resection margin (61 center dot 7 versus 31 per cent respectively; P <0 center dot 001). Conclusion Quality assessment of surgical practice may have a major impact on oncological outcome after surgery for upper rectal cancer.

KW - QUALITY-OF-LIFE

KW - LOCAL RECURRENCE

KW - NEOADJUVANT THERAPY

KW - ANTERIOR RESECTION

KW - COLORECTAL-CANCER

KW - BOWEL DYSFUNCTION

KW - HIGH-RISK

KW - POPULATION

KW - SURGERY

KW - TRIAL

U2 - 10.1002/bjs5.50242

DO - 10.1002/bjs5.50242

M3 - Journal article

C2 - 32207568

VL - 4

SP - 274

EP - 283

JO - BJS Open

JF - BJS Open

SN - 2474-9842

IS - 2

ER -