Читать книгу Surgical Management of Advanced Pelvic Cancer - Группа авторов - Страница 27

Radiologic assessment of local and distant disease in the setting of advanced pelvic cancer can be challenging. Therefore all diagnostic imaging is assessed by radiologists and nuclear medicine physicians with specific expertise in cancer imaging prior to the MDTM. An expert radiologist familiar with surgical principles may anticipate the expected organ involvement. Regular contact in the oncological network ensures that referring hospitals know which scan sequences and modalities that are required.

Table 2.1 Differences between hospitals caring for “regular” colorectal cancer patients and hospitals caring for locally advanced and recurrent pelvic cancer patients (Example from The Netherlands).

Regular care for colorectal cancer	Specialized pelvic cancer care
Consultants with special interest in colorectal cancer	Consultants with special interest in locally advanced and pelvic cancer
Two radiologists	Two radiologists with verifiable expertise in evaluation of locally advanced and recurrent pelvic cancer, before and after neoadjuvant treatment
Two surgeons	Two surgeons with verifiable technical expertise in treatment of locally advanced and recurrent pelvic cancer. At least one surgeon with expertise in treatment of stage 4 colorectal cancer
One pathologist	Pathologist with specific expertise in evaluation of specimens of the pelvis and effects of neoadjuvant therapy
One radiation oncologist	Radiation oncologist with expertise in treatment of locally advanced and recurrent pelvic cancer. Expertise in IORT = Intra‐operative radiotherapy
One medical oncologist	Medical oncologist with specific expertise in curative treatment of patients with locally advanced and recurrent pelvic cancer
	Extra: Oncological urologist with expertise in urinary deviation
	Extra: Oncological gynecologist with expertise in postoperative care and recovery
	Extra: plastic and reconstructive surgeon with expertise in reconstruction of large oncological defects
24/7 intervention radiology	Experience with acquiring tissue from the pelvis and placing drains in the pelvis, including transgluteal approaches
Stomatherapy nurse clinic	Stomatherapy nurse experienced in care of urinary stoma
protocol for referral for IORT	Provides IORT
MDTM operates according to national guideline	MDTM discusses many patients that cannot be treated according to national guideline
Includes all patients in Dutch Surgical Colorectal Audit (DSCA)	Includes only T4 in audit. Registers all patients in prospective databases, compares with other T4/locally recurrent rectal cancer (LRRC) centers, and publishes results