Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes

A. Bhangu, J. Beynon, G. Brown, G. Chang, P. Das, A. Desai, F. Frizelle, R. Glynne-Jones, R. Goldin, M. A. Hawkins, A. Heriot, S. Laurberg, A. Mirnezami, B. Moran, R. J. Nicholls, P. Sagar, P. Tekkis, T. Vuong, M. Wilson, S. M. AliA. Antoniou, P. Bose, K. Boyle, G. Branagan, D. Burling, S. K. Clark, P. Colquhoun, C. H. Crane, A. Darzi, M. Davies, C. P. Delaney, D. Dietz, Eric Dozois, M. Duff, A. Dziki, J. Faria, J. E. Fitzgerald, P. Georgiou, B. George, M. L. George, A. Gupta, R. Guy, D. P. Harji, D. A. Harris, D. Herzig, T. Holm, R. Hompes, L. Jeys, J. T. Jenkins, R. P. Kiran, C. E. Koh, W. L. Law, A. S. Liberman, M. Marshall, D. R. McArthur, N. Mortensen, E. Myers, P. R. O'Connell, S. T. O'Dwyer, A. Oliver, A. Pallan, P. Patel, U. B. Patel, S. Radley, K. W.D. Ramsey, P. C. Rasmussen, C. Richard, H. J.T. Rutten, D. Sebag-Montefiore, M. J. Solomon, L. Stocchi, C. J. Swallow, D. M. Tait, E. Tan, N. Van As, T. Wiggers, J. H.W. de Wilt, D. C. Winter, C. Woodhouse

Research output: Contribution to journalReview article

70 Citations (Scopus)

Abstract

Background: The management of primary rectal cancer beyond total mesorectal excision planes (PRCbTME) and recurrent rectal cancer (RRC) is challenging. There is global variation in standards and no guidelines exist. To achieve cure most patients require extended, multivisceral, exenterative surgery, beyond conventional totalmesorectal excision planes. The aim of the Beyond TME Group was to achieve consensus on the definitions and principles of management, and to identify areas of research priority. Methods: Delphi methodology was used to achieve consensus. The Group consisted of invited experts from surgery, radiology, oncology and pathology. The process included two international dedicated discussion conferences, formal feedback, three rounds of editing and two rounds of anonymized webbased voting. Consensus was achieved with more than 80 per cent agreement; less than 80 per cent agreement indicated low consensus. During conferences held in September 2011 and March 2012, open discussion took place on areas in which there is a low level of consensus. Results: The final consensus document included 51 voted statements, making recommendations on ten key areas of PRC-bTME and RRC. Consensus agreement was achieved on the recommendations of 49 statements, with 34 achieving consensus in over 95 per cent. The lowest level of consensus obtained was 76 per cent. There was clear identification of the need for referral to a specialist multidisciplinary team for diagnosis, assessment and further management. Conclusion: The consensus process has provided guidance for the management of patients with PRCbTME or RRC, taking into account global variations in surgical techniques and technology. It has further identified areas of research priority.

Original languageEnglish (US)
JournalBritish Journal of Surgery
Volume100
Issue number8
DOIs
StatePublished - Jan 1 2013

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Rectal Neoplasms
Politics
Research
Radiology
Referral and Consultation
Guidelines
Pathology
Technology

ASJC Scopus subject areas

  • Surgery

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Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. / Bhangu, A.; Beynon, J.; Brown, G.; Chang, G.; Das, P.; Desai, A.; Frizelle, F.; Glynne-Jones, R.; Goldin, R.; Hawkins, M. A.; Heriot, A.; Laurberg, S.; Mirnezami, A.; Moran, B.; Nicholls, R. J.; Sagar, P.; Tekkis, P.; Vuong, T.; Wilson, M.; Ali, S. M.; Antoniou, A.; Bose, P.; Boyle, K.; Branagan, G.; Burling, D.; Clark, S. K.; Colquhoun, P.; Crane, C. H.; Darzi, A.; Davies, M.; Delaney, C. P.; Dietz, D.; Dozois, Eric; Duff, M.; Dziki, A.; Faria, J.; Fitzgerald, J. E.; Georgiou, P.; George, B.; George, M. L.; Gupta, A.; Guy, R.; Harji, D. P.; Harris, D. A.; Herzig, D.; Holm, T.; Hompes, R.; Jeys, L.; Jenkins, J. T.; Kiran, R. P.; Koh, C. E.; Law, W. L.; Liberman, A. S.; Marshall, M.; McArthur, D. R.; Mortensen, N.; Myers, E.; O'Connell, P. R.; O'Dwyer, S. T.; Oliver, A.; Pallan, A.; Patel, P.; Patel, U. B.; Radley, S.; Ramsey, K. W.D.; Rasmussen, P. C.; Richard, C.; Rutten, H. J.T.; Sebag-Montefiore, D.; Solomon, M. J.; Stocchi, L.; Swallow, C. J.; Tait, D. M.; Tan, E.; Van As, N.; Wiggers, T.; de Wilt, J. H.W.; Winter, D. C.; Woodhouse, C.

In: British Journal of Surgery, Vol. 100, No. 8, 01.01.2013.

Research output: Contribution to journalReview article

Bhangu, A, Beynon, J, Brown, G, Chang, G, Das, P, Desai, A, Frizelle, F, Glynne-Jones, R, Goldin, R, Hawkins, MA, Heriot, A, Laurberg, S, Mirnezami, A, Moran, B, Nicholls, RJ, Sagar, P, Tekkis, P, Vuong, T, Wilson, M, Ali, SM, Antoniou, A, Bose, P, Boyle, K, Branagan, G, Burling, D, Clark, SK, Colquhoun, P, Crane, CH, Darzi, A, Davies, M, Delaney, CP, Dietz, D, Dozois, E, Duff, M, Dziki, A, Faria, J, Fitzgerald, JE, Georgiou, P, George, B, George, ML, Gupta, A, Guy, R, Harji, DP, Harris, DA, Herzig, D, Holm, T, Hompes, R, Jeys, L, Jenkins, JT, Kiran, RP, Koh, CE, Law, WL, Liberman, AS, Marshall, M, McArthur, DR, Mortensen, N, Myers, E, O'Connell, PR, O'Dwyer, ST, Oliver, A, Pallan, A, Patel, P, Patel, UB, Radley, S, Ramsey, KWD, Rasmussen, PC, Richard, C, Rutten, HJT, Sebag-Montefiore, D, Solomon, MJ, Stocchi, L, Swallow, CJ, Tait, DM, Tan, E, Van As, N, Wiggers, T, de Wilt, JHW, Winter, DC & Woodhouse, C 2013, 'Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes', British Journal of Surgery, vol. 100, no. 8. https://doi.org/10.1002/bjs.9192_1
Bhangu, A. ; Beynon, J. ; Brown, G. ; Chang, G. ; Das, P. ; Desai, A. ; Frizelle, F. ; Glynne-Jones, R. ; Goldin, R. ; Hawkins, M. A. ; Heriot, A. ; Laurberg, S. ; Mirnezami, A. ; Moran, B. ; Nicholls, R. J. ; Sagar, P. ; Tekkis, P. ; Vuong, T. ; Wilson, M. ; Ali, S. M. ; Antoniou, A. ; Bose, P. ; Boyle, K. ; Branagan, G. ; Burling, D. ; Clark, S. K. ; Colquhoun, P. ; Crane, C. H. ; Darzi, A. ; Davies, M. ; Delaney, C. P. ; Dietz, D. ; Dozois, Eric ; Duff, M. ; Dziki, A. ; Faria, J. ; Fitzgerald, J. E. ; Georgiou, P. ; George, B. ; George, M. L. ; Gupta, A. ; Guy, R. ; Harji, D. P. ; Harris, D. A. ; Herzig, D. ; Holm, T. ; Hompes, R. ; Jeys, L. ; Jenkins, J. T. ; Kiran, R. P. ; Koh, C. E. ; Law, W. L. ; Liberman, A. S. ; Marshall, M. ; McArthur, D. R. ; Mortensen, N. ; Myers, E. ; O'Connell, P. R. ; O'Dwyer, S. T. ; Oliver, A. ; Pallan, A. ; Patel, P. ; Patel, U. B. ; Radley, S. ; Ramsey, K. W.D. ; Rasmussen, P. C. ; Richard, C. ; Rutten, H. J.T. ; Sebag-Montefiore, D. ; Solomon, M. J. ; Stocchi, L. ; Swallow, C. J. ; Tait, D. M. ; Tan, E. ; Van As, N. ; Wiggers, T. ; de Wilt, J. H.W. ; Winter, D. C. ; Woodhouse, C. / Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. In: British Journal of Surgery. 2013 ; Vol. 100, No. 8.
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title = "Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes",
abstract = "Background: The management of primary rectal cancer beyond total mesorectal excision planes (PRCbTME) and recurrent rectal cancer (RRC) is challenging. There is global variation in standards and no guidelines exist. To achieve cure most patients require extended, multivisceral, exenterative surgery, beyond conventional totalmesorectal excision planes. The aim of the Beyond TME Group was to achieve consensus on the definitions and principles of management, and to identify areas of research priority. Methods: Delphi methodology was used to achieve consensus. The Group consisted of invited experts from surgery, radiology, oncology and pathology. The process included two international dedicated discussion conferences, formal feedback, three rounds of editing and two rounds of anonymized webbased voting. Consensus was achieved with more than 80 per cent agreement; less than 80 per cent agreement indicated low consensus. During conferences held in September 2011 and March 2012, open discussion took place on areas in which there is a low level of consensus. Results: The final consensus document included 51 voted statements, making recommendations on ten key areas of PRC-bTME and RRC. Consensus agreement was achieved on the recommendations of 49 statements, with 34 achieving consensus in over 95 per cent. The lowest level of consensus obtained was 76 per cent. There was clear identification of the need for referral to a specialist multidisciplinary team for diagnosis, assessment and further management. Conclusion: The consensus process has provided guidance for the management of patients with PRCbTME or RRC, taking into account global variations in surgical techniques and technology. It has further identified areas of research priority.",
author = "A. Bhangu and J. Beynon and G. Brown and G. Chang and P. Das and A. Desai and F. Frizelle and R. Glynne-Jones and R. Goldin and Hawkins, {M. A.} and A. Heriot and S. Laurberg and A. Mirnezami and B. Moran and Nicholls, {R. J.} and P. Sagar and P. Tekkis and T. Vuong and M. Wilson and Ali, {S. M.} and A. Antoniou and P. Bose and K. Boyle and G. Branagan and D. Burling and Clark, {S. K.} and P. Colquhoun and Crane, {C. H.} and A. Darzi and M. Davies and Delaney, {C. P.} and D. Dietz and Eric Dozois and M. Duff and A. Dziki and J. Faria and Fitzgerald, {J. E.} and P. Georgiou and B. George and George, {M. L.} and A. Gupta and R. Guy and Harji, {D. P.} and Harris, {D. A.} and D. Herzig and T. Holm and R. Hompes and L. Jeys and Jenkins, {J. T.} and Kiran, {R. P.} and Koh, {C. E.} and Law, {W. L.} and Liberman, {A. S.} and M. Marshall and McArthur, {D. R.} and N. Mortensen and E. Myers and O'Connell, {P. R.} and O'Dwyer, {S. T.} and A. Oliver and A. Pallan and P. Patel and Patel, {U. B.} and S. Radley and Ramsey, {K. W.D.} and Rasmussen, {P. C.} and C. Richard and Rutten, {H. J.T.} and D. Sebag-Montefiore and Solomon, {M. J.} and L. Stocchi and Swallow, {C. J.} and Tait, {D. M.} and E. Tan and {Van As}, N. and T. Wiggers and {de Wilt}, {J. H.W.} and Winter, {D. C.} and C. Woodhouse",
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TY - JOUR

T1 - Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes

AU - Bhangu, A.

AU - Beynon, J.

AU - Brown, G.

AU - Chang, G.

AU - Das, P.

AU - Desai, A.

AU - Frizelle, F.

AU - Glynne-Jones, R.

AU - Goldin, R.

AU - Hawkins, M. A.

AU - Heriot, A.

AU - Laurberg, S.

AU - Mirnezami, A.

AU - Moran, B.

AU - Nicholls, R. J.

AU - Sagar, P.

AU - Tekkis, P.

AU - Vuong, T.

AU - Wilson, M.

AU - Ali, S. M.

AU - Antoniou, A.

AU - Bose, P.

AU - Boyle, K.

AU - Branagan, G.

AU - Burling, D.

AU - Clark, S. K.

AU - Colquhoun, P.

AU - Crane, C. H.

AU - Darzi, A.

AU - Davies, M.

AU - Delaney, C. P.

AU - Dietz, D.

AU - Dozois, Eric

AU - Duff, M.

AU - Dziki, A.

AU - Faria, J.

AU - Fitzgerald, J. E.

AU - Georgiou, P.

AU - George, B.

AU - George, M. L.

AU - Gupta, A.

AU - Guy, R.

AU - Harji, D. P.

AU - Harris, D. A.

AU - Herzig, D.

AU - Holm, T.

AU - Hompes, R.

AU - Jeys, L.

AU - Jenkins, J. T.

AU - Kiran, R. P.

AU - Koh, C. E.

AU - Law, W. L.

AU - Liberman, A. S.

AU - Marshall, M.

AU - McArthur, D. R.

AU - Mortensen, N.

AU - Myers, E.

AU - O'Connell, P. R.

AU - O'Dwyer, S. T.

AU - Oliver, A.

AU - Pallan, A.

AU - Patel, P.

AU - Patel, U. B.

AU - Radley, S.

AU - Ramsey, K. W.D.

AU - Rasmussen, P. C.

AU - Richard, C.

AU - Rutten, H. J.T.

AU - Sebag-Montefiore, D.

AU - Solomon, M. J.

AU - Stocchi, L.

AU - Swallow, C. J.

AU - Tait, D. M.

AU - Tan, E.

AU - Van As, N.

AU - Wiggers, T.

AU - de Wilt, J. H.W.

AU - Winter, D. C.

AU - Woodhouse, C.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Background: The management of primary rectal cancer beyond total mesorectal excision planes (PRCbTME) and recurrent rectal cancer (RRC) is challenging. There is global variation in standards and no guidelines exist. To achieve cure most patients require extended, multivisceral, exenterative surgery, beyond conventional totalmesorectal excision planes. The aim of the Beyond TME Group was to achieve consensus on the definitions and principles of management, and to identify areas of research priority. Methods: Delphi methodology was used to achieve consensus. The Group consisted of invited experts from surgery, radiology, oncology and pathology. The process included two international dedicated discussion conferences, formal feedback, three rounds of editing and two rounds of anonymized webbased voting. Consensus was achieved with more than 80 per cent agreement; less than 80 per cent agreement indicated low consensus. During conferences held in September 2011 and March 2012, open discussion took place on areas in which there is a low level of consensus. Results: The final consensus document included 51 voted statements, making recommendations on ten key areas of PRC-bTME and RRC. Consensus agreement was achieved on the recommendations of 49 statements, with 34 achieving consensus in over 95 per cent. The lowest level of consensus obtained was 76 per cent. There was clear identification of the need for referral to a specialist multidisciplinary team for diagnosis, assessment and further management. Conclusion: The consensus process has provided guidance for the management of patients with PRCbTME or RRC, taking into account global variations in surgical techniques and technology. It has further identified areas of research priority.

AB - Background: The management of primary rectal cancer beyond total mesorectal excision planes (PRCbTME) and recurrent rectal cancer (RRC) is challenging. There is global variation in standards and no guidelines exist. To achieve cure most patients require extended, multivisceral, exenterative surgery, beyond conventional totalmesorectal excision planes. The aim of the Beyond TME Group was to achieve consensus on the definitions and principles of management, and to identify areas of research priority. Methods: Delphi methodology was used to achieve consensus. The Group consisted of invited experts from surgery, radiology, oncology and pathology. The process included two international dedicated discussion conferences, formal feedback, three rounds of editing and two rounds of anonymized webbased voting. Consensus was achieved with more than 80 per cent agreement; less than 80 per cent agreement indicated low consensus. During conferences held in September 2011 and March 2012, open discussion took place on areas in which there is a low level of consensus. Results: The final consensus document included 51 voted statements, making recommendations on ten key areas of PRC-bTME and RRC. Consensus agreement was achieved on the recommendations of 49 statements, with 34 achieving consensus in over 95 per cent. The lowest level of consensus obtained was 76 per cent. There was clear identification of the need for referral to a specialist multidisciplinary team for diagnosis, assessment and further management. Conclusion: The consensus process has provided guidance for the management of patients with PRCbTME or RRC, taking into account global variations in surgical techniques and technology. It has further identified areas of research priority.

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U2 - 10.1002/bjs.9192_1

DO - 10.1002/bjs.9192_1

M3 - Review article

C2 - 23901427

AN - SCOPUS:84896058553

VL - 100

JO - British Journal of Surgery

JF - British Journal of Surgery

SN - 0007-1323

IS - 8

ER -