A Multidisciplinary Approach for Advanced Colorectal Cancer
As the incidence of colorectal cancer and difficult cases demanding complex clinical decisions have increased and multimodal treatment strategies have been much developed, the need for a multidisciplinary team (MDT) approach is increasing for treating col
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A Multidisciplinary Approach for Advanced Colorectal Cancer Nam Kyu Kim and Youn Young Park
Abstract
As the incidence of colorectal cancer and difficult cases demanding complex clinical decisions have increased and multimodal treatment strategies have been much developed, the need for a multidisciplinary team (MDT) approach is increasing for treating colorectal cancer patients in that MDT approach would allow more tailored treatment for complex or advanced colorectal cancer patients. In this chapter, the background of increasing need of MDT and its impacts on various aspects are dealt with, and the factors affecting the efficacy of MDT clinics are reviewed. This chapter will help you to establish the basic concept of MDT and to review evidences advocating its positive impacts as well as some debate issues. Keywords
Multidisciplinary team (MDT) · Colorectal cancer
N. K. Kim(*) Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea e-mail: [email protected] Y. Y. Park Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
Colorectal cancer is the fourth leading cause of cancer mortality and the second most common malignancy worldwide [1]. In Korea, the incidence rate of colorectal cancer has increased rapidly and was predicted to be the most common cancer among men for the first time in 2016 [2]. Although early detection rates of colorectal cancer are increasing since a mass screening system has been established, around 70% of newly diagnosed colorectal cancer patients still demonstrate advanced tumors that are not primarily resectable, and synchronous liver metastases are present in approximately 30% of them [3, 4]. As surgical techniques such as the introduction of total mesorectal excision (TME), complete mesocolic excision (CME) with central vessel ligation (CVL), and the use of minimally invasive surgery (MIS) have advanced and various chemotherapeutic agents and radiation techniques have developed, the era of multimodal treatments has been established in colorectal cancer. With the use of multimodal treatments, available treatment regimens with various therapeutic orders have been more complicated in an effort to achieve higher R0 resection rates in advanced colorectal cancer. Owing to these attempts to convert initially unresectable tumors to resectable tumors, a fine boundary of operability no longer exists. In this context, a multidisciplinary team (MDT) approach is integral to achieve a highly tailored therapy for better oncological and clinical outcomes. MDT care has increasingly been imple-
© Springer Nature Singapore Pte Ltd. 2018 N. K. Kim et al. (eds.), Surgical Treatment of Colorectal Cancer, https://doi.org/10.1007/978-981-10-5143-2_2
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N. K. Kim and Y. Y. Park
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mented throughout Asian countries including South Korea, where the colorectal cancer incidence is rapidly increasing; thereby, the number of difficult cases that need more complex clinical decisions is increasing simultaneously.
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