Treatment of Colorectal Cancer: a Multidisciplinary Approach

  • G Anania
  • G Resta
  • S Marino
  • N Fabbri
  • L Scagliarini
  • I Marchitelli
  • F Fiorica
  • G Cavallesco
Original Research



Colorectal cancer is the third most prevalent cancer in the world, preceded by prostate and lung cancers in men (10%) and breast and lung cancers in women (9.4%). Colorectal cancer is the fourth leading cause of death in men (7.6%) and the third in women (8.6%). A multidisciplinary approach has radically changed the way we deal with this disease among all specialist fields.


In this study, we propose comparing the multidisciplinary experience group (started in 2012) of S. Anna Hospital (University of Ferrara) with the previous approach to rectal cancer before the advent of the multidisciplinary program.


We find that more study depth of neoplastic disease as well as of each individual patient leads to more accurate staging and to a weighted therapy based on the needs of the individual. All the studies were performed in accordance with the guidelines established by the European and Italian associations.


Colorectal cancer Multidisciplinary group Laparoscopic surgery 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer Incidence and Mortality Worldwide: Sources, Methods and Major Patterns in GLOBOCAN 2012: Globocan 2012. Int J Cancer. March 1, 2015;136(5):E359–86. Scholar
  2. 2.
    Valentini V, Aristei C, Glimelius B, Minsky BD, Beets-Tan R, Borras JM, et al. Multidisciplinary rectal cancer management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2). Radiother Oncol: J Eur Soc Ther Radiol Oncol. 92(2, August 2009):148–63.
  3. 3.
    Garcia-Aguilar J, Glynne-Jones R, Schrag D. Multimodal rectal cancer treatment: in some cases, less may be more. Am Soc Clin Oncol Educ Book/ASCO Am Soc Clin Oncol Meeting. 2016;35:92–102. Scholar
  4. 4.
    Loria FS, Iseas S, O’Connor JM, Pairola A, Chacon M, Mendez G, et al. Non-surgical management (NSM) of rectal cancer. series of 68 cases, long follow up in two leading centres in Argentina. Digestive and Liver Disease. June 1, 2016;0(0)
  5. 5.
    Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg. March 2003;90(3):355–64. Scholar
  6. 6.
    Bipat S, Glas AS, Slors FJM, Zwinderman AH, Bossuyt PMM, Stoker J. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis. Radiology. September 2004;232(3):773–83. Scholar
  7. 7.
    Sievers CK, Kratz JD, Zubringen LD, LoConte NK, Lubner SJ, Uboha N, et al. The multidisciplinary management of colorectal cancer: present and future paradigms. Clin Colon Rectal Surg. 2016 Sep;29(3):232–8.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Fiorica F,  Trovò M, Anania G, Marcello D, Di Benedetto F, Marzola M, D’Acapito F, Nasti G, Berretta M. Is It Possible a Conservative Approach After Radiochemotherapy in Locally Advanced Rectal Cancer (LARC)? A Systematic Review of the Literature and Meta-analysis J Gastrointest Cancer. 2017.
  9. 9.
    Broc G, Gana K, Denost Q, Quintard B. Decision-making in rectal and colorectal cancer: systematic review and qualitative analysis of surgeons. Psychol Health Med. 2017 Apr;22(4):434–48.CrossRefPubMedGoogle Scholar
  10. 10.
    Kontovounisios C, Tan E, Pawa N, Brown G, Tait D, Cunningham D, Rasheed S, Tekkis P, “Selection process can improve the outcome in locally advanced and recurrent colorectal cancer: activity and results of a dedicated multidisciplinary colorectal cancer centre” Colorecatl dis, 2016 Sep 15.Google Scholar
  11. 11.
    Tomasone JR, Brouwers MC, Vukmirovic M, Grunfeld E, O'Brien MA, Urquhart R, Walker M, Webster F, Fitch M. “Interventions to improve care coordination between primary healthcare and oncology care providers: a systematic review” ESMO Open 2016;1:e000077.
  12. 12.
    You YN, Baxter NN, Stewart A, Nelson H. Is the increasing rate of local excision for stage I rectal cancer in the united states justified?: a nationwide cohort study from the National Cancer Database. Ann Surg. May 2007;245(5):726–33. Scholar
  13. 13.
    Heald RJ. Total mesorectal excision. The new European Gold Standard. Il Giornale Di Chirurgia. July 1998;19(6–7):253–5.PubMedGoogle Scholar
  14. 14.
    Enker WE. Total mesorectal excision—the new golden standard of surgery for rectal cancer. Ann Med. April 1997;29(2):127–33.CrossRefPubMedGoogle Scholar
  15. 15.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC Trial): multicentre, randomised controlled trial. Lancet (London, England). May 14, 2005;365(9472):1718–26. Scholar
  16. 16.
    Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet (London, England). June 29, 2002;359(9325):2224–9. Scholar
  17. 17.
    Veldkamp R, Kuhry E, Wim CJ, Hop J, Jeekel G, Kazemier HJB, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. The Lancet Oncology. July 2005;6(7):477–84. Scholar
  18. 18.
    Staudacher C, Di Palo S, Tamburini A, Vignali A, Orsenigo E. Total mesorectal excision (TME) with laparoscopic approach: 226 consecutive cases. Surg Oncol. December 2007;16(Suppl 1):S113–6. Scholar
  19. 14.
    Pugliese R, Di Lernia S, Sansonna F, Maggioni D, Ferrari GC, Magistro C, et al. Laparoscopic resection for rectal adenocarcinoma. Eur J Surg Oncol: J Eur Soc Surg Oncol Br Assoc Surg Oncol. May 2009;35(5):497–503. Scholar
  20. 20.
    Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MHGM, Klerk ESM d L-d, et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. April 2, 2015;372(14):1324–32. Scholar
  21. 21.
    D’Annibale A, Morpurgo E, Fiscon V, Trevisan P, Sovernigo G, Orsini C, et al. Robotic and laparoscopic surgery for treatment of colorectal diseases. Dis Colon rectum. December 2004;47(12):2162–8.
  22. 22.
    Sammour T, Kahokehr A, Srinivasa S, Bissett IP, Hill AG. Laparoscopic colorectal surgery is associated with a higher intraoperative complication rate than open surgery. Ann Surg. January 2011;253(1):35–43.CrossRefPubMedGoogle Scholar
  23. 23.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC Trial): multicentre, randomised controlled trial. Lancet (London, England). May 14, 2005;365(9472):1718–26. Scholar
  24. 24.
    Thorpe, H., D. G. Jayne, P. J. Guillou, P. Quirke, J. Copeland, J. M. Brown, and Medical Research Council Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer Trial Group. “Patient factors influencing conversion from laparoscopically assisted to open surgery for colorectal cancer.” The British Journal of Surgery 95, no. 2 (February 2008): 199–205. doi:

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Morphology, Experimental Medicine and Surgery, Section of General and Thoracic SurgeryUniversity of FerraraFerraraItaly
  2. 2.University of FerraraFerraraItaly
  3. 3.Department of Radiation OncologyUniversity Hospital FerraraFerraraItaly

Personalised recommendations