Multi-disciplinary Consultation of Colorectal Cancer: One-stop Solution to Difficult Tumors

Link of the Original Article:

https://mp.weixin.qq.com/s/m7rFXrNdTBvAbfNibyCIqQ

September,2022, for a case of recurrent and metastatic colorectal cancer, the Comprehensive Cancer Center of Shanghai General Hospital (South Campus) held a multidisciplinary discussion. The meeting was presided over by Li Jikun, director of Gastroenterology Department. Experts from the Department of Oncology, Radiology, Pathology, Nuclear Medicine, Imaging Medicine, Ultrasound, Molecular Center together with patients and their families attended the meeting.

On March 1, 2022, the patient underwent radical right hemicolectomy in a county in Hubei Province, where the mass was found to be fused with the peritoneum and kidney intraoperatively, making complete resection impossible, and therefore treated with palliative resection and electrocautery. Postoperative pathology showed moderate to low differentiated adenocarcinoma with pathological stage pT4N1M1 (peritoneum). After surgery, the patient had poor appetite and right low back pain, and came to our hospital in June. The upper abdominal CT examination showed multiple metastases in the abdominal cavity and peritoneum. The patients and his family are very concerned about the risk of reoperation, the follow-up treatment and the recovery. Therefore, after the first diagnosis, Director Chen Donghui proposed to further determine the treatment plan by the multidisciplinary discussion. Experts inquired and estimated the patients' condition, the progressive examination results and the treatment plan. Huang Qian, director of the Cancer Molecular Diagnosis Center, gave a detailed interpretation of the genetic test report. The experts from each department made a rigorous and detailed analysis of the case from their perspective and elaborated their opinions on the treatment plan, providing standardized and precise suggestions for the patient's treatment in the next stage.

The patient was performed radical right hemicolectomy on March 1, 2022 in a certain county of Hubei province, where the mass was found to be fused with the peritoneum and kidney intraoperatively, making complete resection impossible, and therefore treated with palliative resection and electrocautery. Postoperative pathology showed moderate to low differentiated adenocarcinoma with pathological stage pT4N1M1 (peritoneum). After surgery, the patient had poor appetite and right low back pain, and came to our hospital in June this year. CT examination of the upper abdomen showed multiple metastases in the abdominal cavity and peritoneum. Whether surgery could be performed again, the risk of follow-up treatment and the healing situation were issues of great concern to the patient and his family. Therefore, after the first consultation in the Department of Medical Oncology, Director Chen Donghui proposed a multidisciplinary discussion to further determine the patient's treatment plan. During the meeting, experts from various departments inquired about the patient's condition and summarized the development of the patient's condition, examination results and the treatment plan taken since the first visit. Huang Qian, director of tumor molecular diagnosis center, gave a detailed interpretation of the patient's genetic test report. The experts from each department also made a rigorous and detailed analysis of the case from their own specialties and elaborated their consultation opinions and treatment suggestions for the patient respectively, providing standardized and precise suggestions for the patient's next treatment.

After the meeting, Director Li Jikun explained the change of the patient's condition and the choice of postoperative treatment for the patient and his family in plain language. The patient and his family expressed full understanding and were willing to actively cooperate with the doctor for treatment.

Recently, the Department of Oncology found that the patient was well tolerated after chemotherapy, with obvious effect, and there was a phenomenon of tumor regression, which might lead to the risk of peritonitis perforation. So it again conducted a multidisciplinary discussion (MDT) in conjunction with other departments such as gastrointestinal surgery. At the meeting, the Radiology Department analyzed the imaging data of patients and identified the risks of follow-up treatment. Experts from other departments also expressed their views and opinions. Li Jikun, director of Gastroenterology Department, put forward a follow-up standardized treatment plan for the purpose of improving the quality of life of patients.

The family expressed their gratitude to the experts. Through two rounds of multi-disciplinary discussions (MDT), patients and their families fully understood the progress of the disease and the possibility of follow-up treatment. It shows that multidisciplinary discussion (MDT) plays an important role in regulating clinical diagnosis and treatment and promoting doctor-patient communication.

The Southern Colorectal Cancer Center (CrCC) is led by Prof.Li Jikun, director of Gastrointestinal Surgery Department, and Prof.Huang Qian, director of Molecular Diagnosis Center. Through multi-disciplinary discussion, it forms a holistic management with core disciplines as the main subject and relevant disciplines as the participation, to improve personalized diagnosis and treatment for patients with colorectal cancer. According to the latest certification data in 2020, a total of 280 patients were enrolled in the first-south CCC Comprehensive Cancer Center for Colorectal Cancer, with the enrollment rate of more than 90%. The number of preoperative discussions accounted for 64% of the total number of participants. The postoperative discussion rate was 100%. Among the enrolled patients, CCC Comprehensive Cancer Center conducts family history survey, psychological consultation and social work services. In addition, the center regularly follows up, asks patients about their recovery and treatment after surgery, and reminds patients of taking regular physical examination, giving full play to the health management concept of integrated medicine

Experts participating in the Southern CCC colorectal cancer conference: Li Jikun team, Huang Qian team, Yuan Lin team, Chen Donghui, Xu Yi, Liu Changcun, Zhao Guangming, Cao Rong.

Correpondents: Xian Liu, Min Shi, Oncology Center, SGH