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The Impact of LOREC on Rectal Cancer Management in Northumbria NHS Trust
A Bell, J O’Sullivan, J Hatt, MR Kalbassi, SJ Mills
What is LOREC?
• Low Rectal Cancer National Development Programme • Launched in October 2010 • Four main elements: 15 LOREC workshops for colorectal MDT members 6 cadaveric workshops for surgeons Access to “in-house” or “outreach” surgical mentoring 6 MRI training workshops for radiologists
• Northumbria attended 10th October 2012
Aims of the LOREC programme
Methods
5 year period: 1/4/2010 - 31/3/2015 • Demographics • Staging • Management (surgery alone vs. short course vs. long
course) • Histopathological findings Primary outcome - +ve CRM (margin <1mm) Pre-LOREC - 2010/11 + 2011/12 Post-LOREC - 2013/14 + 2014/15
453 Rectal Cancers
49 (11%) Local resection
273 (60%) Surgical resection
131 (29%) No resection
128 (47%) Surgery only
57 (21%) Short course
RXT
88 (32%) Long course RXT/CXT
Demographics
For the 273 patients undergoing surgical resection:
• M:F ratio of 2.5:1 • Mean age: 67.8 years (34-91) • 7 consultants over 2 sites • 247/273 (90%) - Consultant grade 1st surgeon • ASA II or III
Operations performed
0%
25%
50%
75%
100%
Pre-LOREC Post-LOREC
APRAnterior resectionHartmann'sPanproctocolectomy
Stoma formation
104 (38%) End stoma
169 (62%) Anastomosis
150 (89%) Defunctioned
19 (11%) Not defunctioned
273 Resections
0%
25%
50%
75%
100%
Pre-LOREC Post-LOREC
Laparoscopic Open
0%
25%
50%
75%
100%
Pre-LOREC Post-LORECSurgery alone Short courseLong course
CRM positivity
+ve CRM -ve CRM TotalPre-LOREC 8 (6.1%) 131 (93.9%) 139
Post-LOREC 6 (7.0%) 86 (93%) 92
Total 15 260 231
p value = 0.7808
Conclusions
• No change in positive circumferential resection margin rates pre- and post LOREC.
• The effect of LOREC has been to halve the use of neoadjuvant therapy and virtually eradicate use of SC radiotherapy.
Thankyou
Any questions?