How Should a Multi-disciplinary Team (MDT) Approach the Issue of Non-Operative Management in Rectal Cancer?

• DOI: 10.1007/s11888-015-0291-4
• Publication Date: 2015-09-16T02:41:11Z
• Authors: Rob Glynne-Jones; Angela Wheeler; Kyle Dunlea; Colin Elton; Gary Atkin; Luis Soares; Elaine Burns; Sheida Vessal; Lauren Carp; Margaret Lynch; Matthew Train
• Keywords: 03 medical and health sciences; 0302 clinical medicine; 3. Good health

A sustained clinical complete response (CCR) after preoperative chemoradiation (CRT) is observed in 10–20 % of patients with locally advanced rectal cancer (LARC). A selective non-operative management with close surveillance is increasingly being advocated for patients achieving a CCR—on the assumption that outcomes compare favourably with patients subjected to radical surgery (usually requiring a permanent stoma). The aim of this present opinion piece was to capture individual views of an MDT and elicit common themes regarding the question “How should a multi-disciplinary team (MDT) approach the issue of non-operative management in rectal cancer?” A vignette of a real patient was discussed, and all members explained their own perspective in the context of the vignette. Several common themes emerged. Long-term prospective observational studies and randomized studies with more uniform inclusion criteria are required to evaluate the risk-benefit of the standard surgical approach compared against a non-operative approach.