Practice patterns for complex situations in the management of rectal cancer: A multidisciplinary inter-group national survey.

GOAL: To report the current clinical practice of French physicians for rectal cancer in various complex settings.

METHODS: Nineteen clinical situations and four surveillance modalities were proposed to a panel of experts via 11 learned societies. The answers of 48 experts and the impact of colorectal specialists on therapeutic options were compared to those of other participants.

RESULTS: A total of 722 physicians [surgeons=319 (44%), gastro-intestinal oncologists=305 (42%), radiotherapists=98 (14%)] participated in this study. The mean number of answers per question was 500. A consensus was reached in 19 clinical situations. Approaches according to specialty were similar in most situations. In seven settings, the therapeutic strategy differed significantly (interval between the end of chemo-radiation and surgery, attitude based on response of neo-adjuvant therapy, treatment of usT1N0 or pT1sm2 tumors after endoscopic resection, adjuvant therapy for pT3N1 tumors, interval to protective stoma closure, and schedule of follow-up surveillance). There was disagreement between experts and non-experts with regard to three management plans (contra-indications for neo-adjuvant chemo-radiation therapy, strategy according to response to neo-adjuvant therapy, and date of protective stoma closure).

CONCLUSION: This survey provides an overview of current practice of a selected group of French physicians. Sound knowledge of the current literature and case-by-case discussion with a group of experts from each involved specialty during a multidisciplinary conference are essential. Certain complex cases should be presented to expert centers to validate the therapeutic approach.