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Journal of Gastrointestinal Surgery

, Volume 17, Issue 10, pp 1863–1868 | Cite as

Multidisciplinary Management of Rectal Cancer: the OSTRICH

  • David W. DietzEmail author
  • on behalf of the Consortium for Optimizing Surgical Treatment of Rectal Cancer (OSTRiCh)
Evidence-Based Current Surgical Practice

Abstract

Background

Disparity exists in outcomes for rectal cancer patients in the US. Similar problems in several European countries have been addressed by the creation of national networks of rectal cancer centers of excellence (CoEs) that follow evidence-based care pathways and specified protocols of care and process and are certified by regular external validation.

Aim

This paper reviews the current status of rectal cancer care in the US and examines the evidence for multidisciplinary rectal cancer management. A US rectal cancer CoE system based on the existing UK model is proposed.

Methods

A literature search was performed for publications related to US rectal cancer outcomes, multidisciplinary management of rectal cancer, and European rectal cancer programs.

Results

US rectal cancer outcomes are highly variable. The majority of US rectal cancer patients are treated by generalists in low-volume hospitals. Current evidence supports five main principles of rectal cancer care that have been incorporated into European rectal cancer CoE programs. These programs have dramatically improved rectal cancer outcomes in Scandanavian countries and the UK.

Conclusions

A similar CoE program should be established in the US to improve the outcomes of rectal cancer patients.

Keywords

Rectal cancer Centers of excellence Multidisciplinary management Multidisciplinary team OSTRiCH Total mesorectal excision 

Notes

References

  1. 1.
    Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin 2007;57(1):43–66.Google Scholar
  2. 2.
    McArdle CS, Hole D. Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival. BMJ. 1991 Jun 22;302(6791):1501–5.Google Scholar
  3. 3.
    Archampong D, Borowski D, Wille-Jørgensen P, Iverson LH. Workload and surgeon´s specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev. 2012 Mar 14;3:CD005391.Google Scholar
  4. 4.
    Kreiter E, Yasui Y, de Gara C, White J, Winget M. Referral rate to oncologists and its variation by hospital for colorectal cancer patients. Ann Surg Oncol. 2012 Mar;19(3):714–21.Google Scholar
  5. 5.
    Wexner SD, Rotholtz NA. Surgeon infleunced variables in resectional rectal cancer surgery. DCR, 2000;43(11):1606–1627CrossRefGoogle Scholar
  6. 6.
    Ricciardi R, Roberts PL, Read TE, Marcello PW, Schoetz DJ, Baxter NN. Variability in reconstructive procedures following rectal cancer surgery in the United States. Dis Colon Rectum. 2010 Jun;53(6):874–80.Google Scholar
  7. 7.
    Etzioni DA, Cannom RR, Madoff RD, Ault GT, Beart RW Jr. Colorectal procedures: what proportion is performed by American board of colon and rectal surgery-certified surgeons? Dis Colon Rectum. 2010 May;53(5):713–20.Google Scholar
  8. 8.
    Ricciardi R, Roberts PL, Read TE, Baxter NN, Marcello PW, Schoetz DJ. Who performs proctectomy for rectal cancer in the United States? Dis Colon Rectum. 2011 Oct;54(10):1210–5.Google Scholar
  9. 9.
    Heald, R. J. and R. D. Ryall. "Recurrence and survival after total mesorectal excision for rectal cancer." Lancet 1986, 1(8496): 1479–1482.PubMedCrossRefGoogle Scholar
  10. 10.
    Qureshi A, Verma A, Ross P, Landau D. Colorectal cancer treatment. 2008. Clinical Evidence, BMJ Publishing Group.Google Scholar
  11. 11.
    Maurer CA, Renzulli P, Kull C, Käser SA, Mazzucchelli L, Ulrich A, Büchler MW. The impact of the introduction of total mesorectal excision on local recurrence rate and survival in rectal cancer: long-term results. Ann Surg Oncol 2011, 18(7): 1899–1906.PubMedCrossRefGoogle Scholar
  12. 12.
    Martling A, Holm T, Rutqvist LE, Johansson H, Moran BJ, Heald RJ, Cedermark B. Impact of a surgical training programme on rectal cancer outcomes in Stockholm. The British journal of surgery. Feb 2005;92(2):225–229.Google Scholar
  13. 13.
    Maslekar S, Sharma A, Macdonald A, Gunn J, Monson JR, Hartley JE. Mesorectal grades predict recurrences after curative resection for rectal cancer. Dis Colon Rectum. 2007 Feb;50(2):168–75.Google Scholar
  14. 14.
    Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol. 2002 Apr 1;20(7):1729–34.Google Scholar
  15. 15.
    Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, O’Callaghan C, Myint AS, Bessell E, Thompson LC, Parmar M, Stephens RJ, Sebag-Montefiore D. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet. 2009 Mar 7;373(9666):821–8.Google Scholar
  16. 16.
    Mercury Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 2006;333:779.Google Scholar
  17. 17.
    Lahaye MJ, Engelen SM, Nelemans PJ, Beets GL, van de Velde CJ, van Engelshoven JM, Beets-Tan RG. Imaging for predicting the risk factors—the circumferential resection margin and nodal disease—of local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR 2005;26:259–68.PubMedCrossRefGoogle Scholar
  18. 18.
    Nougaret S, Rouanet P, Molinari N, Pierredon MA, Bibeau F, Azria D, Lemanski C, Assenat E, Duffour J, Ychou M, Reinhold C, Gallix B. MR Volumetric Measurement of Low Rectal Cancer Helps Predict Tumor Response and Outcome after Combined Chemotherapy and Radiation Therapy. Radiology. 2012 Mar 21; 263(2):409–418. doi: 10.1148/radiol.12111263.Google Scholar
  19. 19.
    Burton S, Brown G, Daniels IR, Norman AR, Mason B, Cunningham D. MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins? Br J Cancer. 2006 Feb 13;94(3):351–7.Google Scholar
  20. 20.
    Taylor FG, Quirke P, Heald RJ, Moran B, Blomqvist L, Swift I, Sebag-Montefiore DJ, Tekkis P, Brown G. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg. 2011;253(4):711–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Valentini V, Beets-Tan R, Borras JM, Krivokapić Z, Leer JW, Påhlman L, Rödel C, Schmoll HJ, Scott N, Velde CV, Verfaillie C. Evidence and research in rectal cancer. Radiotherapy & Oncology 2008;87:449–74.CrossRefGoogle Scholar
  22. 22.
    Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731–40.PubMedCrossRefGoogle Scholar
  23. 23.
    Qureshi A, Verma A, Ross P, Landau D. Colorectal cancer treatment. 2008. Clinical Evidence, BMJ Publishing Group.Google Scholar
  24. 24.
    NCCN. Clinical Practice Guidelines in Oncology. Rectal Cancer. 2009.Google Scholar
  25. 25.
    Peeters KC, van de Velde CJ, Leer JW, Martijn H, Junggeburt JM, Kranenbarg EK, Steup WH, Wiggers T, Rutten HJ, Marijnen CA. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients--a Dutch colorectal cancer group study. J Clin Oncol 2005;23:6199–206.PubMedCrossRefGoogle Scholar
  26. 26.
    Stephens RJ, Thompson LC, Quirke P, Steele R, Grieve R, Couture J, Griffiths GO, Sebag-Montefiore D. Impact of short-course preoperative radiotherapy for rectal cancer on patients’ quality of life: data from the Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial. J Clin Oncol 28: 4233–9.Google Scholar
  27. 27.
    Gabel M, Hilton NE, Nathanson SD. Multidisciplinary breast cancer clinics. Do they work? Cancer. 1997 Jun 15;79(12):2380–4.Google Scholar
  28. 28.
    Chang JH, Vines E, Bertsch H, Fraker DL, Czerniecki BJ, Rosato EF, Lawton T, Conant EF, Orel SG, Schuchter L, Fox KR, Zieber N, Glick JH, Solin LJ. The impact of a multidisciplinary breast cancer center on recommendations for patient management: the University of Pennsylvania experience. Cancer. 2001 Apr 1;91(7):1231–7.Google Scholar
  29. 29.
    Stephens MR, Lewis WG, Brewster AE, Lord I, Blackshaw GR, Hodzovic I, Thomas GV, Roberts SA, Crosby TD, Gent C, Allison MC, Shute K. Multidisciplinary team management is associated with improved outcomes after surgery for esophageal cancer. Dis Esophagus. 2006;19(3):164–71.PubMedCrossRefGoogle Scholar
  30. 30.
    Birchall M, Bailey D, King P. Effect of process standards on survival of patients with head and neck cancer in the south and west of England. Br J Cancer. 2004 Oct 18;91(8):1477–81.Google Scholar
  31. 31.
    Coory M, Gkolia P, Yang IA, Bowman RV, Fong KM. Systematic review of multidisciplinary teams in the management of lung cancer. Lung Cancer. 2008 Apr;60(1):14–2Google Scholar
  32. 32.
    Commission on Cancer. Cancer Program Standards 2012. http://www.facs.org/cancer/coc/programstandards2012.pdf. Accessed Date 15 Mar 2012
  33. 33.
    Morris E, Haward RA, Gilthorpe MS, Craigs C, Forman D. The impact of the Calman-Hine report on the processes and outcomes of care for Yorkshire’s colorectal cancer patients. Br J Cancer. 2006 Oct 23;95(8):979–85.Google Scholar
  34. 34.
    Haward RA. The Calman-Hine report: a personal retrospective on the UK’s first comprehensive policy on cancer services. Lancet Oncol. 2006 Apr;7(4):336–46.Google Scholar
  35. 35.
    Khani MH, Smedh K. Centralization of rectal cancer surgery improves long-term survival. Colorectal disease , Sep 2010;12(9):874–879.Google Scholar
  36. 36.
    Dahlberg M, Glimelius B, Påhlman L. Changing strategy for rectal cancer is associated with improved outcome. Br J Surg 1999,86(3): 379–384.PubMedCrossRefGoogle Scholar
  37. 37.
    Wibe A, Møller B, Norstein J, Carlsen E, Wiig JN, Heald RJ, Langmark F, Myrvold HE, Søreide O. A national strategic change in treatment policy for rectal cancer--implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum 2002, 45(7): 857–866.PubMedCrossRefGoogle Scholar
  38. 38.
    Bülow S, Harling H, Iversen LH, Ladelund S. Survival after rectal cancer has improved considerably in Denmark—secondary publication. Ugeskr Laeger 2009, 171(38): 2735–2738.PubMedGoogle Scholar
  39. 39.
    Department of Health. The NHS Cancer plan: a plan for investment, a plan for reform. 27 September 2000Google Scholar
  40. 40.
    Team, N. C. A. “National Cancer Peer Review Programme. 2006” Manual for Cancer Services.Google Scholar
  41. 41.
    Team, N. C. A. “National Cancer Peer Review Programme. 2008” Manual for Cancer Services Colorectal Measures.Google Scholar
  42. 42.
    Team, N. C. A. “National Cancer Peer Review Programme. 2011” Handbook for Cancer Services.Google Scholar
  43. 43.
    McArdle, C. S. and D. J. Hole . “Influence of volume and specialization on survival following surgery for colorectal cancer.” Br J Surg 2004,91(5): 610–617.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • David W. Dietz
    • 1
    • 2
    Email author
  • on behalf of the Consortium for Optimizing Surgical Treatment of Rectal Cancer (OSTRiCh)
  1. 1.Department of Colorectal Surgery, Digestive Disease InstituteCleveland ClinicClevelandUSA
  2. 2.ClevelandUSA

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