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International variation in managing locally advanced or recurrent rectal cancer: prospective benchmark analysis

dc.rights.licenseopenen_US
dc.contributor.authorDENOST, Q.
dc.contributor.authorSOLOMON, M.
dc.contributor.authorTUECH, J. J.
dc.contributor.authorGHOUTI, L.
dc.contributor.authorCOTTE, E.
dc.contributor.authorPANIS, Y.
dc.contributor.authorLELONG, B.
dc.contributor.authorROUANET, Philippe
dc.contributor.authorFAUCHERON, J. L.
dc.contributor.authorJAFARI, M.
dc.contributor.authorLEFEVRE, J. H.
dc.contributor.authorRULLIER, E.
dc.contributor.authorHERIOT, A.
dc.contributor.authorAUSTIN, K.
dc.contributor.authorLEE, P.
dc.contributor.authorBROWN, W.
dc.contributor.authorMAILLOU-MARTINAUD, H.
dc.contributor.authorSAVEL, H.
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorQUINTARD, Bruno
dc.contributor.authorBROC, G.
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorSAILLOUR-GLENISSON, Florence
dc.date.accessioned2021-01-21T10:48:17Z
dc.date.available2021-01-21T10:48:17Z
dc.date.issued2020
dc.identifier.issn1365-2168 (Electronic) 0007-1323 (Linking)en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/25942
dc.description.abstractEnBackground Tumour extension beyond the mesorectal plane (ymrT4) occurs in 5–10 per cent of patients with rectal cancer and 10 per cent of patients develop locally recurrent rectal cancer (LRRC) after primary surgery. There is global variation in healthcare delivery for these conditions. Methods An international benchmark trial of the management of ymrT4 tumours and LRRC was undertaken in France and Australia between 2015 and 2017. Heterogeneity in management and operative decision‐making were analysed by comparison of surgical resection rates, blinded intercountry reading of pelvic MRI, quality‐of‐life assessment and qualitative evaluations. Results Among 154 patients (97 in France and 57 in Australia), 31·8 per cent had ymrT4 disease and 68·2 per cent LRRC. The surgical resection rates were 88 and 79 per cent in France and Australia respectively (P = 0·112). The concordance in operative planning was low (κ = 0·314); the rate of pelvic exenteration was lower in France than Australia both in clinical practice (36 of 78 versus 34 of 40; P < 0·001) and in theoretical conditions (10 of 25 versus 50 of 57; P = 0·002). The R0 resection rate was lower in France than Australia for LRRC (25 of 49 versus 18 of 21; P = 0·007) but not for ymrT4 tumours (21 of 26 versus 15 of 15; P = 0·139). Morbidity rates were similar. Patients who underwent non‐exenterative procedures had higher scores on the mental functioning subscale at 12 months (P = 0·047), and a lower level of distress at 6 months (P = 0·049). Qualitative analysis highlighted five categories of psychosocial factors influencing treatment decisions: patient, strategy, specialist, organization and culture. Conclusion This international benchmark trial has highlighted the differences in worldwide treatment of locally advanced and LRRC. Standardized care should improve outcomes for these patients.
dc.language.isoENen_US
dc.title.enInternational variation in managing locally advanced or recurrent rectal cancer: prospective benchmark analysis
dc.title.alternativeBr J Surgen_US
dc.typeArticle de revueen_US
dc.identifier.doi10.1002/bjs.11854en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed32786027en_US
bordeaux.journalBritish Journal of Surgeryen_US
bordeaux.page1846-1854en_US
bordeaux.volume107en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - U1219en_US
bordeaux.issue13en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.teamEMOSen_US
bordeaux.teamEPICENE_BPH
bordeaux.teamHACS
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.identifierhal-03117523
hal.version1
hal.date.transferred2021-01-21T10:48:22Z
hal.exporttrue
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