Angela Maurizi, MD1, Susanna Mazzocato, MD2, Roberto Campagnacci, MD, PhD1. 1General Surgery, ASUR Regione Marche, “Carlo Urbani” Hospital, Jesi, Italy, 2Department of General Surgery, Università Politecnica delle Marche, 60126 Ancona, Italy
INTRODUCTION: Nowadays, treatment decisions about patients with rectal cancer are increasingly made within the context of a multi-disciplinary team (MDT) meeting. The outcomes of rectal cancer patients before and after the era of multi-disciplinary team was analyzed and compared in this paper. The purpose of the present study is to evaluate the value of discussing rectal cancer patients in a multi-disciplinary team.
METHODS AND PROCEDURES: In our health institute, weekly MDT conferences were initiated in January 2015. Meetings were attended by surgeons, radiologists, radiation and medical oncologists and key nursing personnel. All rectal cancer patients diagnosed and treated in 2014-2015 in the General Surgery Division of the “Carlo Urbani” hospital in Jesi (AN, Italy) were included. Then, the data from rectal cancer patients in 2014 were evaluated, before the adoption of MDT and in year 2015, after the adoption of meetings. Datasets regarding demographics, tumor stage, treatment, and outcomes based on pathology after operation were obtained. During an MDT discussion patient history, clinical and psychological condition, co-morbidity, modes of work-up, clinical staging, and optimal treatment strategies were discussed. A database was created to include each patient’s workup, treatments to date and recommendations by each specialty. ‘‘Demographic variables’’ consisted of age at diagnosis, sex, body mass index, comorbidities, American Society of Anesthesiologists physical status classification system, clinical stage and pathological stage. Other analyzed variables included baseline carcinoembryonic antigen (CEA), the type of imaging, use of neoadjuvant chemo-radiation, restaging following neoadjuvant therapy, distance from the anal verge, operation type and use of adjuvant chemo-radiation. ‘‘Outcome variables’’ consisted in a comparison for each group between clinical and pathological stage.
RESULTS: Sixty-five patients were included in this study: thirty patients in 2014 (pre-MDT) and thirty-five patients in 2015. Demographic variables did not differ significantly between groups. Preoperative clinical stages with baseline preoperative CEA and postoperative pathological stage were analysed, too. Thanks to the MDT and the increased use of the neoadjuvant therapy, a statistically significant difference in reduction of the stage between the clinical and pathological stage in the patients of the MDT group was verified.
CONCLUSIONS: The vast majority of rectal MDT decisions were implemented and when decisions changed, it mostly related to patient factors that had not been taken into account prior to the adoption of multi-disciplinary team. Analysis of the implementation of team decisions is an informative process in order to monitor the quality of MDT decision-making.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86178
Program Number: P210
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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