Читать книгу Surgical Management of Advanced Pelvic Cancer - Группа авторов - Страница 26

Patients with locally advanced primary and recurrent pelvic cancers are associated with a higher risk of local recurrence, distant metastases, and poor survival. Furthermore, these complex pelvic tumors require several specialties for an accurate preoperative evaluation, neoadjuvant and/or adjuvant therapy with a multidisciplinary surgical approach, (Table 2.1). Preoperative treatments providing downstaging are essential to both increase the chance of radical resections and prevent unnecessarily extensive resections that lead to impairment. Centralization is warranted, to identify those patients who require this specialized care.

Figure 2.1 National registries help to monitor outcome. In this control chart for proportions, a decrease in R+ resection rate seems to be statistically significant and leads to differences in the mean R+ resection rate. This moment (referred to as ‘out of control’) coincides with the change of preoperative treatment in locally recurrent pelvic cancer patients (unpublished data). CL, Control limit; UCL, upper control limit.

In order to work toward a situation in which all patients with locally advanced cancers are discussed in a complex cancer MDTM, it is essential that it is easily accessible for physicians outside the specialized center.