Referral patterns and outcomes of a highly specialised pelvic exenteration multidisciplinary team meeting: A retrospective cohort study |
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| Institution: | 1. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia;2. Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia;3. RPA Institute of Academic Surgery (IAS), Sydney, Australia;4. The University of Sydney, New South Wales, Australia;1. Dept. of Oncological Urology, University Medical Center Utrecht, Postbox 85500, 3508, GA, Utrecht, the Netherlands;2. Dept. of Urology, The Netherlands Cancer Institute, Post Box 90203, 1006 BE, Amsterdam, the Netherlands;1. Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China;2. Department of Clinical Medicine of year 2017, Dalian Medical University, PR China;1. Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan;2. Division of Surgery, Keio University School of Medicine, Tokyo, Japan;3. Medical Genetics Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan;4. Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan;5. SRL, Inc., Tokyo, Japan;6. Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan;7. Shizuoka Cancer Center, Shizuoka, Japan;1. JCOG Data Center/ Operations Office, National Cancer Center, Japan;2. Gastric Surgery Division, National Cancer Center Hospital, Japan;3. Department of Gastroenterological Surgery, Toranomon Hospital, Japan;4. Department of Surgery, Gifu Municipal Hospital, Japan;5. Department of Gastroenterological Surgery, Shizuoka General Hospital, Japan;6. Department of Surgery, Kansai Rosai Hospital, Japan;7. Department of Digestive Surgery, Tenri Hospital, Japan;8. Department of Gastric Surgery, Tokyo Medical and Dental University, Japan;9. Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Japan;10. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan;11. Department of Surgery, Yodogawa Chrisitan Hospital, Japan;12. Department of Gastric Surgery, Shizuoka Cancer Center, Japan;1. Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands;2. Department of Oncology, Oslo University Hospital, Oslo, Norway;3. K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Oslo, Norway;4. Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway;5. Department of Clinical Medicine, University of Bergen, Bergen, Norway;6. Regional Centre of Excellence of Palliative Care Western Norway, Haukeland University Hospital, Bergen, Norway;7. Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands;8. Department of Medical Oncology, Leiden University Medical Centre, Leiden, the Netherlands;9. Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway;1. Department of Otolaryngology - Head and Neck Surgery, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Republic of Korea;2. Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea;3. Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, Republic of Korea |
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| Abstract: | IntroductionThe purpose of this study was to review recommendations made from a specialist pelvic exenteration (PE) multidisciplinary team (MDT) and to provide insights as to the impact of the MDT on patient selection and clinical decision making.Materials & methodsA retrospective review was conducted at Royal Prince Alfred Hospital's PE MDT between June 2014 and December 2015. Data was collected from the recorded minutes of MDT meetings. Referral information and clinical data was extracted from individual patient files. Additional data including operative dates and surgical resection margins were collected from electronic medical records.ResultsOf the 183 patients considered for PE during the MDT meeting, 104 (57%) were recommended for surgery. Factors that influenced the recommendation in favour of surgery were referral by a surgeon (P = 0.004), referral from a rural location (P = 0.05) and having locally advanced primary cancer (P < 0.001). Patients who were seen by the unit's surgeon prior to the MDT did not impact on the MDT recommendation nor the decision for or against surgery (P = 0.771). The most common reason for recommendation against PE was unresectable distant metastatic disease (43%).ConclusionsThe PE MDT meeting is a critical step in the patient care pathway and facilitates critical decision making. Anatomically-based contraindications to surgery (i.e. involvement of adjacent organs, bone and neurovascular structures) do not appear to influence MDT decision making regarding resectability. |
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| Keywords: | Pelvic exenteration Multidisciplinary team Surgical outcomes |
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