Open AccessConsensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes
Author(s) -
Simak Ali,
Anthony Antoniou,
J. Bey,
Aneel Bhangu,
P. Bose,
Kirsten Boyle,
Graham Branagan,
Gina Brown,
David Burling,
George J. Chang,
Susan Clark,
Patrick Colquhoun,
Christopher H. Crane,
Ara Darzi,
Prajnan Das,
Johannes H. W. de Wilt,
Conor P. Delaney,
Anant Desai,
Mark Davies,
David W. Dietz,
Eric J. Dozois,
M. J. Duff,
Adam Dziki,
J Edward Fitzgerald,
Frank A. Frizelle,
Bruce George,
Mark George,
Panagiotis Georgiou,
R. Glynne-Jones,
Robert Goldin,
Arun Gupta,
Deena Harji,
Dean Harris,
Maria A. Hawkins,
Alexander G. Heriot,
Torbjørn Holm,
Roel Hompes,
Lee Jeys,
John T. Jenkins,
Ravi P. Kiran,
Cherry Koh,
Søren Laurberg,
Wai Lun Law,
A. Sender Liberman,
M Marshall,
D. Ray McArthur,
Alex H. Mirnezami,
Brendan Moran,
Neil Mortenson,
E. Myers,
R. J. Nicholls,
P. R. O'Connell,
Sarah T O’Dwyer,
Alex Oliver,
Arvind Pallan,
Prashant Patel,
Uday Patel,
Simon Radley,
Kelvin Ramsey,
P. Rasmussen,
Carole Richard,
H.J.T. Rutten,
P. M. Sagar,
David SebagMontefiore,
Michael J. Solomon,
Luca Stocchi,
Carol J. Swallow,
Diana Tait,
Ek Khoon Tan,
Paris Tekkis,
Nicholas van As,
T. Vuong,
Theo Wiggers,
Malcolm S Wilson,
Desmond C. Winter,
Christopher Woodhouse
Publication year - 2013
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.9192
Subject(s) - medicine , total mesorectal excision , delphi method , colorectal cancer , delphi , referral , consensus conference , multidisciplinary approach , multidisciplinary team , voting , general surgery , surgery , medical physics , family medicine , cancer , nursing , statistics , social science , mathematics , sociology , politics , computer science , political science , law , operating system
Consensus abstract Background The management of primary rectal cancer beyond total mesorectal excision planes ( PRC‐bTME ) and recurrent rectal cancer ( RRC ) is challenging. There is global variation in standards and no guidelines exist. To achieve cure most patients require extended, multivisceral, exenterative surgery, beyond conventional total mesorectal excision planes. The aim of the Beyond TME Group was to achieve consensus on the definitions and principles of management, and to identify areas of research priority. Methods Delphi methodology was used to achieve consensus. The Group consisted of invited experts from surgery, radiology, oncology and pathology. The process included two international dedicated discussion conferences, formal feedback, three rounds of editing and two rounds of anonymized web‐based voting. Consensus was achieved with more than 80 per cent agreement; less than 80 per cent agreement indicated low consensus. During conferences held in September 2011 and March 2012, open discussion took place on areas in which there is a low level of consensus. Results The final consensus document included 51 voted statements, making recommendations on ten key areas of PRC‐bTME and RRC . Consensus agreement was achieved on the recommendations of 49 statements, with 34 achieving consensus in over 95 per cent. The lowest level of consensus obtained was 76 per cent. There was clear identification of the need for referral to a specialist multidisciplinary team for diagnosis, assessment and further management. Conclusion The consensus process has provided guidance for the management of patients with PRC‐bTME or RRC , taking into account global variations in surgical techniques and technology. It has further identified areas of research priority.