How do we manage early rectal cancer? A national questionnaire survey among members of the ACPGBI after the preliminary results of the MRC CR07/NCIC CO16 randomized trial.

ABSTRACT

OBJECTIVE: The role of neoadjuvant radiotherapy in the management of rectal cancers has not reached a consensus in colorectal surgical practice. In the light of the preliminary results of the CRO7 trial, we undertook a national questionnaire survey to assess the current pattern of practice in the UK. The aim of this study was to assess the correlation between CRO7 trial results and current practice amongst consultant members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI). METHOD: A 14-item questionnaire was designed to inquire into the current management strategy of operable rectal cancers and the possible role of neoadjuvant radiotherapy. The postal questionnaire survey was sent to all the 400 active consultant surgical members of the ACPGBI. RESULTS: Of 400 questionnaires, 200 (50%) were returned fully completed. One hundred and sixty-six (83%) of surgeons did not routinely use neoadjuvant short course radiotherapy (NASCRT) in clinically operable rectal cancers (T1/T2) <15 cm from anal verge with no metastases (The CR07 eligible cohort). Sixty-four (32%) used NASCRT for T3 cancers routinely whereas 76 (38%) used neoadjuvant long course radiotherapy instead. One hundred and fifty-sixty (78%) of the surgeons felt the height of the tumour from the anal verge influenced their decision on NASCRT, while 104 (52%) felt position was important (Anterior/Posterior). Positive anticipated margins of excision on magnetic resonance imaging was a deciding factor for 185 (92.5%) of surgeons in favour of neoadjuvant therapy. Postoperatively in patients who have not had preoperative radiotherapy, 154 (77%) recommended radiotherapy and 155 (77.5%) recommended chemotherapy if the circumferential resection margin was +ve on final pathology. Seventy-eight (39%) of the surgeons have changed their practice after the preliminary results of the CRO7 by adopting NASCRT for treating early rectal cancers. CONCLUSION: Despite the evidence of the CRO7 trial supporting the use of NASCRT for operable rectal cancer, approximately two-third of consultant surgeons in the UK have yet to implement this treatment regime routinely. A change in practice in 39% of surgeons following the early dissemination of trial results indicate that colorectal surgeons practice is guided by scientific evidence. Because the mature trial data have yet to be published, a further survey of practice is warranted after that publication to determine the ultimate impact of this trial. This survey measures the baseline practice to compare changes over the next 2 years.