Do we practice what we preach

Published Date: 19th July 2016

Publication Authors: Ormsby N, Rajaganeshan R

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Background & Aims

There is a lack of conclusive long-term studies evaluating risk and benefit in the surgical management of patients who show a complete pathological response following radiotherapy in rectal cancer. The trend in practice is becoming increasingly conservative. We questioned whether increased age and/or comorbidity influenced management when complete pathological response was detected.

Methods

Questionnaires were submitted to all the colorectal cancer surgeons within Merseyside. The participants were asked for their practice in managing 3 patient cohorts (60, 70, 80 years of age) with complete pathological response and varying comorbid status. They were also asked for their preference if they faced the same scenario personally.

Results

10 colorectal cancer units with 33 colorectal surgeons were surveyed. The response rate was 23/33 (70%). 5% of surgeons would offer surgery to 70-80 year old patients with multiple comorbidities, whereas 22% would if the patient was 60. 27% of surgeons would offer surgery an 80 year old with no medical comorbidities, and 55% would if they were 60 with no comorbidities. 66% of surgeons would not have surgery if they personally had completely response. 44% would want different treatment from what they would offer their patients.

Conclusions

Patients with complete response get different treatment according to surgeon preference. 44% of surgeons would advise their patients something they would not choose personally. More study into the long-term risk and benefit of surgical vs conservative management of complete responders is required.

Ormsby, N; Joshi, H; Rajaganeshan, R. (2015).  Do we practice what we preach with complete responders in rectal cancer? . European Surgical Research. 55 (Suppl 1), 136

Joshi, H; Ormsby, N; Rajaganeshan, R.. (2015).  Do we practice what we preach with complete responders in rectal cancer? . Gut. 64 (Suppl 1), A353.

Joshi, H; Ormsby, N; Rajaganeshan, R. (2015).  Do we practice what we preach with complete responders in rectal cancer? . Diseases of the Colon & Rectum. 58 (8), e415

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