Fernando Chris, Frizelle Frank, Wakeman Chris, Frampton Chris, Robinson Bridget
University of Otago, Christchurch, Christchurch, New Zealand.
Department of Surgery, University of Otago, Christchurch, Christchurch, New Zealand.
ANZ J Surg. 2017 Nov;87(11):E173-E177. doi: 10.1111/ans.13366. Epub 2015 Nov 3.
New Zealand tumour standards require discussion of all cases of colorectal cancer in a multidisciplinary meeting (MDM), but supporting evidence is lacking. The aim was to determine which patients benefit from MDM discussion.
A retrospective and prospective audit was undertaken of all patients discussed in the Christchurch Hospital colorectal MDM over 12 months to November 2014, who were compared with contemporaneous patients not discussed and identified through Hospital discharge codes.
In total, 641 patients were identified, with 459 (70%) discussed in the MDM, on average 7 years younger than not discussed. The proportion discussed by location was 39.2% colon, 63% rectosigmoid, 98% rectal, 96.6% anal. Discussed patients were more likely to have magnetic resonance imaging (68% cf 9.3%), fluorodeoxyglucose positron emission tomography scan (18% versus 2%) and chest computerized tomography scan (50% versus 26%). For colon cancer, American Joint Committee on Cancer (AJCC) stage I and II, 91% of 68 non-discussed patients went straight to surgery compared with 48% of 27 discussed in the MDM; for AJCC stage III uptake of adjuvant chemotherapy was the same whether discussed or not. An R0 resection was achieved for 91% of discussed patients, and 96% of not discussed. A clear referrer's plan, prospectively recorded in 94 patients, was changed after the MDM in 23%. Clinical staging was changed in 20 patients (4%), none with colon cancers.
Discussion in the MDM influenced management, but was unlikely to change management for AJCC stage I/II colon cancer, who could be spared mandatory review in the MDM and be discussed selectively as treating clinicians decide.
新西兰肿瘤标准要求在多学科会议（MDM）中讨论所有结直肠癌病例，但缺乏支持证据。目的是确定哪些患者能从MDM讨论中获益。
对2014年11月前12个月在克赖斯特彻奇医院结直肠癌MDM中讨论的所有患者进行回顾性和前瞻性审计，并与同期未讨论且通过医院出院编码识别的患者进行比较。
共识别出641例患者，其中459例（70%）在MDM中进行了讨论，平均年龄比未讨论的患者小7岁。按部位划分，讨论的患者比例为：结肠癌39.2%，直肠乙状结肠癌63%，直肠癌98%，肛管癌96.6%。参与讨论的患者更有可能接受磁共振成像检查（68% 对比9.3%）、氟脱氧葡萄糖正电子发射断层扫描（18% 对比2%）和胸部计算机断层扫描（50% 对比26%）。对于结肠癌，美国癌症联合委员会（AJCC）I期和II期，68例未讨论的患者中有91%直接进行了手术，而MDM中讨论的27例患者中有48%；对于AJCC III期，无论是否讨论，辅助化疗的接受率相同。91%参与讨论的患者实现了R0切除，未讨论的患者为96%。在94例患者中前瞻性记录的明确转诊医生计划，在MDM后有23%发生了改变。20例患者（4%）的临床分期发生了改变，其中无结肠癌患者。
MDM中的讨论影响了治疗管理，但对于AJCC I/II期结肠癌不太可能改变治疗管理，这些患者可免于在MDM中进行强制审查，并可根据治疗临床医生的决定进行选择性讨论。
