title: The impact of a dedicated multidisciplinary team on the management of early rectal cancer.
abstract: OBJECTIVE
  Local excision of early rectal cancer (ERCa) offers comparable survival and reduced operative morbidity compared with radical surgery, yet it risks an adverse oncological outcome if performed in the wrong setting. This retrospective review considers the impact of the introduction of a specialist early rectal cancer multidisciplinary team (ERCa MDT) on the investigation and management of ERCa.
  
  
  METHODS
  A retrospective comparative cohort study was undertaken. Patients with a final diagnosis of pT1 rectal cancer at our unit were identified for two 12-month periods before and after the introduction of the specialist ERCa MDT. Data on investigations and therapeutic interventions were compared.
  
  
  RESULTS
  Nineteen patients from 2006 and 24 from 2011 were included. In 2006, 12 patients underwent MRI and four transrectal ultrasound (TRUS) examination, while in 2011, 18 and 20, respectively, received MRI and TRUS. In 2006 four patients underwent incidental ERCa polypectomy, with all having a positive resection margin leading to anterior resection. In 2011 only one case with a positive margin following extended endoscopic mucosal resection was identified. Definitive local excision without subsequent resection occurred in two patients in 2006 and in 16 in 2011.
  
  
  CONCLUSIONS
  The study demonstrates an improvement in preoperative ERCa staging, a reduction in margin positivity and an increase in the use of local excision following the implementation of a specialist ERCa MDT. The increased detection of rectal neoplasms through screening and surveillance programmes requires further investigation and management. A specialist ERCa MDT will improve management and should be available to all practitioners involved with patients with ERCa.
authors.affiliation: Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, UK.
authors.forename: P G
authors.initials: PG
authors.lastname: Vaughan-Shaw
authors.affiliation: Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, UK.
authors.forename: J M D
authors.initials: JM
authors.lastname: Wheeler
authors.affiliation: Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, UK.
authors.forename: N R
authors.initials: NR
authors.lastname: Borley
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D001706:Biopsy; D005260:Female; D006801:Humans; D033162:Incidental Findings; D033183:Interdisciplinary Communication; D007417:Intestinal Polyps / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010348:Patient Care Team / Q000458:organization & administration; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D012007:Rectum / Q000473:pathology; D012189:Retrospective Studies; D000067369:Transanal Endoscopic Microsurgery; D014463:Ultrasonography
keywords: Adenocarcinoma/diagnosis; adenomatous polyps/surgery; microsurgery/methods; rectal neoplasms/diagnosis; rectal neoplasms/surgery