Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2017; 9(6): 153-160
Published online Jun 27, 2017. doi: 10.4240/wjgs.v9.i6.153
Value of multi-disciplinary input into laparoscopic management of rectal cancer - An observational study
Pawan Kumar Dhruva Rao, Sooriyaratchige Pradeep Manjula Peiris, Seema Safia Arif, Rhodri A Davies, Ashraf Gergies Masoud, Puthucode Narayanan Haray
Pawan Kumar Dhruva Rao, Sooriyaratchige Pradeep Manjula Peiris, Seema Safia Arif, Rhodri A Davies, Ashraf Gergies Masoud, Puthucode Narayanan Haray, Department of Colorectal Surgery, Prince Charles Hospital, Merthyr Tydfil CF47 9DT, United Kingdom
Seema Safia Arif, Velindre Cancer Centre, Cardiff CF14 2TL, United Kingdom
Puthucode Narayanan Haray, University of South Wales, Pontypridd, Wales CF37 1DL, United Kingdom
Author contributions: Masoud AG and Haray PN conceived and designed of the study; Arif SS, Davies RA, Masoud AG and Haray PN have all contributed to the data; Dhruva Rao PK and Peiris SPM collected, analysed and interpreted the data; all authors have contributed significantly the drafting and revising the manuscript, and approved the version of the article to be published.
Institutional review board statement: This study was reviewed and approved by the Multidisciplinary team and the institution’s audit department of Prince Charles Hospital, Merthyr Tydfil, United Kingdom.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: No additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Puthucode Narayanan Haray, MBBS, MS, DNB, FRCS, FFST(Ed), Professor, Consultant Colorectal Surgeon, Department of Colorectal Surgery, Prince Charles Hospital, Merthyr Tydfil CF47 9DT, United Kingdom. profpn.haray@wales.nhs.uk
Telephone: +44-1685-728212 Fax: +44-1685-728649
Received: October 24, 2016
Peer-review started: October 27, 2016
First decision: November 22, 2016
Revised: April 2, 2017
Accepted: May 18, 2017
Article in press: May 20, 2017
Published online: June 27, 2017

To assess the impact of multi-disciplinary teams (MDTs) management in optimising the outcome for rectal cancers.


We undertook a retrospective review of a prospectively maintained database of patients with rectal cancers (defined as tumours ≤ 15 cm from anal verge) discussed at our MDT between Jan 2008 and Jan 2011. The data was validated against the national database to ensure completeness of dataset. The clinical course and follow-up data was validated using the institution’s electronic patient records. The data was analysed in terms of frequencies and percentages. Significance of any differences were analysed using χ2 test. A Kaplan-Meier analysis was performed for overall survival and disease free survival.


Following appropriate staging, one hundred and thirty-three patients were suitable for potentially curative resections. Seventy two (54%) were upper rectal cancer (URC) - tumour was > 6 cm from the anal verge and 61 (46%) were lower rectal cancers (LRC) - lower extent of the tumour was palpable ≤ 6 cm. Circumferential resection margin (CRM) appeared threatened on pre-operative MRI in 19/61 (31%) patients with LRC requiring neo-adjuvant therapy (NAT). Of the 133 resections, 118 (89%) were attempted laparoscopically (5% conversion rate). CRM was positive in 9 (6.7%) patients; Median lymph node harvest was 12 (2-37). Major complications occurred in 8 (6%) patients. Median follow-up was 53 mo (0-82). The 90-d mortality was 2 (1.5%). Over the follow-up period, disease related mortality was 11 (8.2%) and overall mortality was 39 (29.3%). Four (3%) patients had local recurrence and 22 (16.5%) patients had distant metastases.


Management of rectal cancers can be optimized with multi-disciplinary input to attain acceptable long-term oncological outcomes even when incorporating a laparoscopic approach to rectal cancer resection.

Keywords: Rectal cancer, Multi-disciplinary management, Laparoscopic rectal resection outcomes

Core tip: Recently, management of rectal cancer has undergone a process of standardization with introduction of total mesorectal excision and use of neo-adjuvant long course chemo-radiotherapy. In the United Kingdom, multimodal therapy is provided under the auspices of multi-disciplinary teams (MDTs). This is the first study to report on the benefits of managing patients jointly within such an MDT.