Abstract:
Objective To investigate the treatment strategies and outcomes of pulmonary recurrence after total mesorectal excision for rectal cancer in a multidisciplinary team (MDT) model and enhance health care quality management.
Methods This retrospective cohort study, conducted from July 2007 to February 2015 at Peking University Cancer Hospital (PKUCH) identified 680 patients with mid-low rectal cancer who received neoadjuvant chemoradiation in combination with total mesorectal excision. We investigated MDT treatment decisions, the final implementation, and survival outcomes of patients with pulmonary recurrence who entered the MDT model.
Results We identified 85 patients with metachronous pulmonary recurrence. Of these, 68 patients were treated within the MDT model at PKUCH. For 28 patients, local treatment with a curative intent was recommended. The other 40 patients received palliative treatment or supportive care. Of the 68 MDT decisions, 61 (89.7%) were implemented. Discordance arose in instances where patients received a more conservative treatment than what was originally recommended. The estimated 3-year survival after recurrence (SAR) rate was significantly different between patients who received curative versus palliative treatment (84.8% vs. 37.6%, P < 0.001).
Conclusions We observed a high concordance between MDT decisions and final implementation in patients with pulmonary rences after total mesorectal excision of rectal cancer. Considerable pulmonary recurrence can be treated with a curative intent, and good outcomes can be achieved through the MDT model used at PKUCH. Patients' participation and social support may contribute to the development of a new MDT model and lay the foundation for enhancing medical quality management.