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Dattani M, Crane S, Battersby NJ, Di Fabio F, Saunders BP, Dolwani S, Rutter MD, Moran BJ. Variations in the management of significant polyps and early colorectal cancer: results from a multicentre observational study of 383 patients. Colorectal Dis 2018; 20:1088-1096. [PMID: 29999580 DOI: 10.1111/codi.14342] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/11/2018] [Indexed: 02/08/2023]
Abstract
AIM The concept of significant polyps and early colorectal cancer (SPECC) encompasses complex polyps not amenable to routine snare polypectomy or where malignancy cannot be excluded. Surgical resection (SR) offers definitive treatment, but is overtreatment for the majority which are benign and amenable to less invasive endoscopic resection (ER). The aim of this study was to investigate variations in the management and outcomes of significant colorectal polyps. METHOD This was a retrospective observational study of significant colorectal polyps, defined as nonpedunculated lesions of ≥ 20 mm size, diagnosed across nine UK hospitals in 2014. Inclusion criteria were endoscopically or histologically benign polyps at biopsy. RESULTS A total of 383 patients were treated by primary ER (87.2%) or SR (12.8%). Overall, 108/383 (28%) polyps were detected in the Bowel Cancer Screening Programme (BCSP). Primary SR was associated with a significantly longer length of stay and major complications (P < 0.01). Of the ER polyps, 290/334 (86.8%) patients were treated without undergoing surgery. The commonest indication for secondary surgery was unexpected polyp cancer, and of these cases 60% had no residual cancer in the specimen. Incidence of unexpected cancer was 10.7% (n = 41) and was similar between ER and SR groups (P = 0.11). On multivariate analysis, a polyp size of > 30 mm and non-BCSP status were independent risk factors for primary SR [OR 2.51 (95% CI 1.08-5.82), P = 0.03]. CONCLUSION ER is safe and feasible for treating significant colorectal polyps. Robust accreditation within the BCSP has led to improvements in management, with lower rates of SR compared with non-BCSP patients. Standardization, training in polyp assessment and treatment within a multidisciplinary team may help to select appropriate treatment strategies and improve outcomes.
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Affiliation(s)
- M Dattani
- Pelican Cancer Foundation, Basingstoke, UK
| | - S Crane
- Pelican Cancer Foundation, Basingstoke, UK
| | - N J Battersby
- Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - F Di Fabio
- Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - B P Saunders
- St Mark's Hospital and Academic Institute, London, UK
| | - S Dolwani
- School of Medicine, Cardiff University, Cardiff, UK
| | - M D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
| | - B J Moran
- Basingstoke and North Hampshire Hospital, Basingstoke, UK
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Battersby NJ, Perez RO, Baxter N, Moran B, Brown G. Session 4: Trying to augment response with chemotherapy: a triumph of hope over experience? Colorectal Dis 2018; 20 Suppl 1:100-102. [PMID: 29878682 DOI: 10.1111/codi.14089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
As part of an approach to improve tumour regression and increase the proportion of patients with complete clinical and radiological response, Dr Perez reviews the methods and evidence base for augmenting therapy and thus augmenting response rates preoperatively. Much of the data reviewed were in the context of patients undergoing a watch-and-wait approach for rectal cancer after initial treatment with chemoradiotherapy.
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Affiliation(s)
| | - R O Perez
- Angelita & Joaquim Gama Institute, São Paulo, Brazil.,Colorectal Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil.,Ludwig Institute for Cancer Research, São Paulo, Brazil.,Gastrointestinal Surgical Oncology Division, Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - N Baxter
- University of Toronto, Toronto, ON, Canada
| | - B Moran
- North Hampshire Hospital, Basingstoke, UK
| | - G Brown
- The Royal Marsden NHS Foundation Trust, London, UK.,Gastrointestinal Cancer Imaging, Imperial College London, London, UK
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Siddiqui MRS, Gormly KL, Bhoday J, Balyansikova S, Battersby NJ, Chand M, Rao S, Tekkis P, Abulafi AM, Brown G. Interobserver agreement of radiologists assessing the response of rectal cancers to preoperative chemoradiation using the MRI tumour regression grading (mrTRG). Clin Radiol 2016; 71:854-62. [PMID: 27381221 DOI: 10.1016/j.crad.2016.05.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/13/2016] [Accepted: 05/03/2016] [Indexed: 02/07/2023]
Abstract
AIM To investigate whether the magnetic resonance imaging (MRI) tumour regression grading (mrTRG) scale can be taught effectively resulting in a clinically reasonable interobserver agreement (>0.4; moderate to near perfect agreement). MATERIALS AND METHODS This study examines the interobserver agreement of mrTRG, between 35 radiologists and a central reviewer. Two workshops were organised for radiologists to assess regression of rectal cancers on MRI staging scans. A range of mrTRGs on 12 patient scans were used for assessment. RESULTS Kappa agreement ranged from 0.14-0.82 with a median value of 0.57 (95% CI: 0.37-0.77) indicating good overall agreement. Eight (26%) radiologists had very good/near perfect agreement (κ>0.8). Six (19%) radiologists had good agreement (0.8≥κ>0.6) and a further 12 (39%) had moderate agreement (0.6≥κ>0.4). Five (16%) radiologists had a fair agreement (0.4≥κ>0.2) and two had poor agreement (0.2>κ). There was a tendency towards good agreement (skewness: 0.92). In 65.9% and 90% of cases the radiologists were able to correctly highlight good and poor responders, respectively. CONCLUSIONS The assessment of the response of rectal cancers to chemoradiation therapy may be performed effectively using mrTRG. Radiologists can be taught the mrTRG scale. Even with minimal training, good agreement with the central reviewer along with effective differentiation between good and intermediate/poor responders can be achieved. Focus should be on facilitating the identification of good responders. It is predicted that with more intensive interactive case-based learning a κ>0.8 is likely to be achieved. Testing and retesting is recommended.
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Affiliation(s)
- M R S Siddiqui
- Department of Colorectal Surgery, Croydon University Hospital, Croydon CR7 7YE, UK; Department of Radiology, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK; Imperial College London, London, UK
| | - K L Gormly
- Dr Jones and Partners, Adelaide, South Australia, Australia
| | - J Bhoday
- Department of Colorectal Surgery, Croydon University Hospital, Croydon CR7 7YE, UK; Department of Radiology, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK; Imperial College London, London, UK
| | - S Balyansikova
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK
| | - N J Battersby
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK
| | - M Chand
- Department of Surgery, University College London, London, UK
| | - S Rao
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK
| | - P Tekkis
- Department of Surgery, Royal Marsden Hospital, Fulham Rd, London SW3 6JJ, UK; Imperial College London, London, UK
| | - A M Abulafi
- Department of Colorectal Surgery, Croydon University Hospital, Croydon CR7 7YE, UK
| | - G Brown
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK; Imperial College London, London, UK.
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Juul T, Battersby NJ, Christensen P, Janjua AZ, Branagan G, Laurberg S, Emmertsen KJ, Moran B. Validation of the English translation of the low anterior resection syndrome score. Colorectal Dis 2015; 17:908-16. [PMID: 25807963 DOI: 10.1111/codi.12952] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 01/25/2015] [Indexed: 02/08/2023]
Abstract
AIM Many patients having anterior resection for rectal cancer suffer from severe long-term bowel dysfunction, known as low anterior resection syndrome (LARS). The LARS score was developed in Denmark, and Swedish, Spanish and German versions have been validated. The aim of this study was to validate the English translation of the LARS score in British rectal cancer patients. METHOD Rectal cancer patients who underwent an anterior resection in 12 UK centres received the LARS score questionnaire, the EORTC QLQ-C30 and a single ad hoc quality of life question. A subgroup of patients received the LARS score questionnaire twice. RESULTS The response rate was 80% and 451 patients were included in the analyses. A strong association between LARS score and quality of life (convergent validity) was found (P < 0.01), discriminative validity was good (P < 0.02) and the test-retest reliability was high (intraclass correlation coefficient 0.83). CONCLUSION The English translation of the LARS score has shown good psychometric properties comparable with recently published results from an international multicentre study. Thus, the English translation of the LARS score can be considered a valid and reliable tool for measuring LARS.
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Affiliation(s)
- T Juul
- Department of Surgery - Section for Colorectal Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - N J Battersby
- The Pelican Cancer Foundation, The Ark, Basingstoke, UK.,Department of Colorectal Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - P Christensen
- Department of Surgery - Section for Colorectal Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A Z Janjua
- The Pelican Cancer Foundation, The Ark, Basingstoke, UK.,Department of Colorectal Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - G Branagan
- Colorectal Surgery, Salisbury NHS Foundation Trust, Basingstoke, UK
| | - S Laurberg
- Department of Surgery - Section for Colorectal Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - K J Emmertsen
- Department of Surgery - Section for Colorectal Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - B Moran
- The Pelican Cancer Foundation, The Ark, Basingstoke, UK.,Department of Colorectal Surgery, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
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Moran BJ, Holm T, Brannagan G, Chave H, Quirke P, West N, Brown G, Glynne-Jones R, Sebag-Montefiore D, Cunningham C, Janjua AZ, Battersby NJ, Crane S, McMeeking A. The English national low rectal cancer development programme: key messages and future perspectives. Colorectal Dis 2014; 16:173-8. [PMID: 24267315 DOI: 10.1111/codi.12501] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/15/2013] [Indexed: 02/08/2023]
Abstract
AIM Adenocarcinoma of the lower rectum is clinically challenging because of the need to choose between a wide excision to achieve oncological clearance, on the one hand, and sphincter conservation to maintain anal function, on the other. The English National Low Rectal Cancer Development Programme (LOREC) was developed under the auspices of the Association of Coloproctology of Great Britain and Ireland and the English National Cancer Action Team to improve the outcome of low rectal cancer in England. METHOD LOREC was initiated focusing on preoperative imaging, selective neoadjuvant therapy, optimal surgical treatment and detailed pathological assessment of the excised specimen. Its key elements were 1-day multidisciplinary team (MDT) workshops, cadaveric surgical training, surgical mentoring, pathological audit and radiological workshops. RESULTS Overall, 147 (89.6%) of 164 MDTs from 151 National Health Service (NHS) Trusts (some with two MDTs) in England participated in 15 workshops in Basingstoke or Leeds. In addition, 112 surgeons attended a 1-day cadaveric training programme in Bristol, Newcastle or Nottingham, with the main focus on extralevator abdominoperineal excision and pelvic reconstruction, with input from anatomists and from colorectal and plastic surgeons. CONCLUSION Optimal staging, selective preoperative chemoradiotherapy and precise surgery were considered as crucial to improve the outcome for patients with low rectal cancer.
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Affiliation(s)
- B J Moran
- Colorectal Surgery, Hampshire Hospitals Foundation Trust, Basingstoke, UK
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