Introduction The management of significant rectal neoplasms and early rectal cancers (ERCa) is vitally dependent on accurate pre-treatment assessment and consideration of all therapeutic options. This study analyses the impact of a formal specialist ERCaMDT on investigation and management of ERCa.
Methods Patients with a final diagnosis of pT1 rectal cancer at our unit were identified for two 12-month periods (2006/2011). Data on investigations and therapeutic interventions were collected from prospectively recorded clinical data.
Results 19 patients from 2006 and 24 patients from 2011 were included. In 2006, 21% (n = 4) patients had undergone polypectomy of an unrecognised polyp cancer with 3 positive resection margins. 3 had MRI, none had trans-rectal ultrasound (TRUS) post-procedure with no use of Transanal Endoscopic Microsurgery (TEMS) to assess margin clearance; three undergoing radical resection. In 2011, 17% (n = 4) underwent ‘inadvertent’ polypectomy but 75% (n = 3) had both MRI and TRUS, with TEMS being used twice to confirm R0 polypectomy. In 2006, 60% (n = 9) lesions undergoing surgical excision had pre-operative MRI and 27% (n = 4) had pre-operative TRUS. Local excision (8 TEMS, 1 per-anal) was used in 60% (n = 9). In 2011, 75% (n = 15) lesions undergoing surgical excision underwent MRI and 85% (n = 17) TRUS. TEMS was initial treatment in 90% (n = 18). 2 patients underwent subsequent resection for adverse pathology and patient choice respectively.
Conclusion We demonstrate an improvement in the investigation of ERCa with implementation of an ERCaMDT and show an decrease in resectional surgery. Where suspicious rectal lesions are encountered, clinicians should be encouraged not to biopsy, and arrange staging via ERCaMDT prior to endoscopic or surgical therapy.
Disclosure of Interest None Declared.