Results of implementation of a fast track pathway for diagnosis of colorectal cancer.

INTRODUCTION: fast track pathways for diagnosis of cancer intend to decrease delays in diagnosis and treatment of cancer. It is recommended to initiate treatment in a period no longer than 30 days since admission in these circuits. AIMS: to know the characteristics and fluency of our Fast Track Diagnostic Pathway (FTDP) for Colorectal Cancer (CRC), with special attention to those patients selected for surgical treatment as a first choice. MATERIAL AND METHOD: all patients who entered the FTDP for CRC during a period of 2 years (2008-2009) were analyzed as well as the rest of patients also diagnosed with CRC but never seen in the FTDP. RESULTS: of the 316 patients referred to the FTDP only 78 (24.7%) were diagnosed as having some kind of cancer derived from the digestive system. At the end 61 patients (19.3%) were diagnosed with CCR. The time interval from entry into the FTDP to the first hospital visit was 3 days (range 1-8), and the interval until colonoscopy was performed was 11.5 days (range 1-41). Fourteen (41.1%) of those patients chosen for surgery were operated on in a period lesser than 30 days while 28 patients (82.3%) underwent surgery before day 45 since admission into the circuit. CONCLUSIONS: though the functioning of the FTDP is acceptable, any increase in number of patients can generate delays. For this reason it is advisable to have a team to assure a good functioning of the FTDP. A proper follow-up of the whole process will possibly avoid unnecessary delays and it will improve coordination of the different phases of the fast track pathway and treatment. As the diagnostic outcome is poor it is mandatory to implement alternatives programs like screening of asymptomatic population, allowing an early detection of this condition.

Resultados de la implementación del circuito de diagnostico rápido de cáncer colorrectal / Results of implementation of a fast track pathway for diagnosis of colorectal cancer

Introducción: los circuitos de diagnóstico rápido de cáncer (CDRC) pretenden disminuir las demoras en el diagnóstico y tratamiento del cáncer colorrectal (CCR). Se recomienda el inicio del primer tratamiento en un plazo de 30 días desde la entrada en el circuito de diagnóstico rápido. Objetivos: conocer las características y fluidez de nuestro circuito de diagnóstico rápido del cáncer colorrectal (CDRC), centrando el interés en los pacientes cuyo primer tratamiento va a ser el quirúrgico. Material y método: se analizan los pacientes que ingresan el circuito de diagnóstico rápido durante un periodo de 2 años (2008- 2009) y también los pacientes diagnosticados durante el tiempo del estudio por otras vías. Resultados: acceden al circuito de diagnóstico rápido 316 pacientes, 78 pacientes (24,7%) presentan cáncer digestivo, siendo finalmente diagnosticados de CCR 61 pacientes (19,3%). El intervalo de tiempo desde la entrada al CDRC hasta la primera visita en el hospital fue de 3 días (rango 1-8), y el intervalo hasta la realización de la colonoscopia fue de 11,5 días (rango 1-41). Los pacientes candidatos a cirugía que fueron intervenidos en un intervalo inferior a 30 días fueron 14 (41,1%), 28 pacientes (82,3%) fueron intervenidos antes de los 45 días. Conclusiones: la rapidez del circuito es aceptable pero cualquier aumento de la demanda puede generar retrasos, con lo que un responsable de seguimiento del proceso posiblemente evitará demoras y mejorará la coordinación en las diferentes fases del circuito y tratamiento. El rendimiento diagnóstico es bajo por lo que hay que pensar en la aplicación de alternativas ya existentes, como el cribado poblacional, que permitan el diagnóstico precoz en pacientes que aún no presentan sintomatología(AU)

Introduction: fast track pathways for diagnosis of cancer intend to decrease delays in diagnosis and treatment of cancer. It is recommended to initiate treatment in a period no longer than 30 days since admission in these circuits. Aims: to know the characteristics and fluency of our Fast Track Diagnostic Pathway (FTDP) for Colorectal Cancer (CRC), with special attention to those patients selected for surgical treatment as a first choice. Material and method: all patients who entered the FTDP for CRC during a period of 2 years (2008-2009) were analyzed as well as the rest of patients also diagnosed with CRC but never seen in the FTDP. Results: of the 316 patients referred to the FTDP only 78 (24.7%) were diagnosed as having some kind of cancer derived from the digestive system. At the end 61 patients (19.3%) were diagnosed with CCR. The time interval from entry into the FTDP to the first hospital visit was 3 days (range 1-8), and the interval until colonoscopy was performed was 11.5 days (range 1-41). Fourteen (41.1%) of those patients chosen for surgery were operated on in a period lesser than 30 days while 28 patients (82.3%) underwent surgery before day 45 since admission into the circuit. Conclusions: though the functioning of the FTDP is acceptable, any increase in number of patients can generate delays. For this reason it is advisable to have a team to assure a good functioning of the FTDP. A proper follow-up of the whole process will possibly avoid unnecessary delays and it will improve coordination of the different phases of the fast track pathway and treatment. As the diagnostic outcome is poor it is mandatory to implement alternatives programs like screening of asymptomatic population, allowing an early detection of this condition(AU)

Long-term follow-up of local rectal cancer surgery by transanal endoscopic microsurgery.

BACKGROUND: In 1997 we launched a prospective program of transanal endoscopic microsurgery (TEM) for the treatment of rectal cancer. METHODS: Suitability for TEM was based on endorectal ultrasound results, classified as follows: (I) benign tumors; (II) adenocarcinomas uT0 and uT1 with uN0; (III) adenocarcinomas uT2- uN0, low histological grade with intention to cure; and (IV) advanced stage adenocarcinomas with palliative care RESULTS: Transanal endoscopic microsurgery was performed in 218 patients: 122 adenomas, and 96 adenocarcinomas: group II-72, group III-19, and group IV-5. Follow-up was >24 months (median 59 months) in 61 patients. Nine were lost to follow-up, and so 52 patients were studied: group II-38, group III-11, and group IV-3. The Kaplan-Meier probability of nonrecurrence of adenocarcinoma by group was 93% in tumors in situ (Tis) and T1; and 77.8% in T2. The Kaplan-Meier probability of survival by group was 100% in Tis and T1 and 82% in T2. CONCLUSIONS: Rates of recurrence and long-term survival in Tis and T1 adenocarcinomas treated with TEM are similar to those in previously published reports using conventional surgery. Further studies are required in T2 adenocarcinomas to determine a definitive strategy.