title: The selection process can improve the outcome in locally advanced and recurrent colorectal cancer: activity and results of a dedicated multidisciplinary colorectal cancer centre.
abstract: OBJECTIVE
  There is wide disparity in the care of patients with multivisceral involvement of rectal cancer. The results are presented of treatment of advanced and recurrent colorectal cancer from a centre where a dedicated multidisciplinary team (MDT) is central to the management.
  
  
  METHODS
  All consecutive MDT referrals between 2010 and 2014 were examined. Analysis was undertaken of the referral pathway, site, selection process, management decision, R0 resection rate, mortality/morbidity/Clavien-Dindo (CD) classification of morbidity, length of stay (LOS) and improvement of quality of life.
  
  
  RESULTS
  There were 954 referrals. These included locally advanced primary rectal cancer (LAPRC b-TME) (39.0%), rectal recurrence (RR) (22.0%), locally advanced primary colon cancer (LAPCC T3c/d-T4) (21.1%), colon cancer recurrence (CR) (12.4%), locally advanced primary anal cancer (LAPAC-failure of CRT/T3c/d-T4) (3.0%) and anal cancer recurrence (AR) (2.2%). Among these patients 271 operations were performed, 212 primary and 59 for recurrence. These included 16 sacrectomies, 134 total pelvic exenterations and 121 other multi-visceral exenterative procedures. An R0 resection (no microscopic margin involvement) was achieved in 94.4% and R1 (microscopic margin involvement) in 5.1%. In LAPRC b-TME the R0 rate was 96.1% and for RR it was 79%. The LOS varied from 13.3 to 19.9 days. RR operations had the highest morbidity (CD 1-2, 33.3%) and LAPRC operations had the highest rate of CD 3-4 complications (18.4%). Most (39.6%) of the referred patients were from other UK hospitals.
  
  
  CONCLUSIONS
  Advanced colorectal cancer can be successfully treated in a dedicated referral centre, achieving R0 resection in over 90% with low morbidity and mortality. Implementation of a standardized referral pathway is encouraged.
authors.affiliation: Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK.|Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Kontovounisios
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Tan
authors.affiliation: Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Pawa
authors.affiliation: Department of Radiology, The Royal Marsden Hospital, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Brown
authors.affiliation: Department of Clinical Oncology, The Royal Marsden Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Tait
authors.affiliation: Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Cunningham
authors.affiliation: Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK.|Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Rasheed
authors.affiliation: Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK.|Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Tekkis
mesh_terms: D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D010348:Patient Care Team; D018579:Patient Selection; D010385:Pelvic Exenteration / Q000379:methods / Q000706:statistics & numerical data*; D011788:Quality of Life; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D006113:United Kingdom
keywords: Beyond TME; MDT; locally advanced and recurrent rectal cancer