title: The effect of multidisciplinary teams for rectal cancer on delivery of care and patient outcome: has the use of multidisciplinary teams for rectal cancer affected the utilization of available resources, proportion of patients meeting the standard of care, and does this translate into changes in patient outcome?
abstract: BACKGROUND
  We hypothesized that mandatory multidisciplinary team (MDT) participation improves process evaluation, outcomes, and technical aspects of surgery for rectal cancer in a stable practice of colorectal surgery.
  
  
  METHODS
  A retrospective review of MDT data was conducted of all patients with colorectal cancer since 2010. Demographic, clinical stage, process evaluation, quality of surgery, and outcome data were collected. Total mesorectal excision and MDT required participation started 2013.
  
  
  RESULTS
  One hundred thirty patients were included in this study: 47 patients in 2014; 41 patients in 2013; and 42 patients pre-MDT. Improvements were seen in 12 of the 14 preoperative process variables, 6 significantly. Improvement in the completeness of total mesorectal excision (0% to 76%) was significant. Local recurrence occurred in 10% of the pre-MDT group, and follow-up is ongoing in the MDT groups.
  
  
  CONCLUSIONS
  MDT participation improves care of patients with rectal cancer. Preoperative clinical staging, multimodality treatment, pathologic staging, and technical aspects of surgery have improved.
authors.affiliation: Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA.
authors.forename: Bradford
authors.initials: B
authors.lastname: Richardson
authors.affiliation: Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA.
authors.forename: John
authors.initials: J
authors.lastname: Preskitt
authors.affiliation: Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA.
authors.forename: Warren
authors.initials: W
authors.lastname: Lichliter
authors.affiliation: Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Peschka
authors.affiliation: Department of Pathology, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Susanne
authors.initials: S
authors.lastname: Carmack
authors.affiliation: Department of Radiology, Baylor University Medical Center, Dallas, TX, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: de Prisco
authors.affiliation: Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA. Electronic address: james.fleshman@baylorhealth.edu.
authors.forename: James
authors.initials: J
authors.lastname: Fleshman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D059039:Standard of Care; D013781:Texas
keywords: Circumferential resection margin; Multi-disciplinary teams; Rectal cancer; Total mesorectal excision