Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 1575 Blondell Ave, Ste 125, Bronx, New York, NY 10461, USA.
Int J Colorectal Dis. 2012 Nov;27(11):1531-8. doi: 10.1007/s00384-012-1501-z. Epub 2012 May 30.
Multidisciplinary teams have become increasingly desirable for managing complex disease but little objective data exist to support this approach. The aim of our study was to determine the impact of a multidisciplinary clinic on the management of colorectal cancer.
Data were prospectively collected on all patients with newly diagnosed colorectal cancer referred to the multidisciplinary clinic at our institution in 2009 and compared to a control group of all patients managed outside the clinic from 2008 to 2009. Comprehensiveness of preoperative evaluation was determined by frequency of abdominal and chest CT, CEA testing, and transrectal ultrasound. Access to multimodal care was measured by frequency of oncology consultation and treatment, advanced pathology testing, genetics counseling, and trial enrollment.
Two hundred eighty-eight patients met inclusion criteria; 88 patients were referred to the clinic (40 preoperative, 48 postoperative) and 200 patients were managed outside. Complete preoperative evaluation was accomplished three times more frequently in clinic patients (85 vs. 23 %, p < 0.0001) with significant improvements in all parameters. Enhanced access to multimodal therapy was demonstrated in clinic patients by increased frequency of oncology consultation (98.9 vs. 61.5 %, p < 0.0001) and treatment (62.5 vs. 41.5 %, p = 0.02), advanced pathology testing (29.6 vs. 10.6 %, p = 0.0001), and genetics counseling (6.8 vs. 1.6 %, p = 0.28). Clinic patients also received significantly higher rates of neoadjuvant therapy for stage II or greater rectal cancer (82.6 vs. 30.9 %, p = 0.0001).
Multidisciplinary clinic management of colorectal cancer is associated with a significantly more complete preoperative evaluation as well as improved access to multimodal therapy.
多学科团队在管理复杂疾病方面变得越来越受欢迎，但几乎没有客观数据支持这种方法。我们的研究目的是确定多学科诊所对结直肠癌治疗的影响。
前瞻性收集了 2009 年我院多学科诊所新诊断为结直肠癌的所有患者的数据，并与 2008 年至 2009 年在诊所外管理的对照组患者进行比较。术前评估的全面性通过腹部和胸部 CT、CEA 检测和直肠超声的频率来确定。多模式治疗的可及性通过肿瘤学咨询和治疗、高级病理检测、遗传咨询和试验参与的频率来衡量。
符合纳入标准的患者有 288 例；88 例患者被转诊至诊所（40 例术前，48 例术后），200 例患者在诊所外治疗。在诊所患者中，完成全面术前评估的频率高三倍（85%比 23%，p<0.0001），所有参数均有显著改善。在诊所患者中，通过增加肿瘤学咨询（98.9%比 61.5%，p<0.0001）和治疗（62.5%比 41.5%，p=0.02）、高级病理检测（29.6%比 10.6%，p=0.0001）和遗传咨询（6.8%比 1.6%，p=0.28），可以获得增强的多模式治疗机会。诊所患者还接受了更高比例的 II 期或更高期直肠肿瘤的新辅助治疗（82.6%比 30.9%，p=0.0001）。
结直肠癌的多学科诊所管理与术前评估更全面以及获得多模式治疗的机会改善有关。
