MDT I AARHUSMDT I AARHUS

Søren LaurbergSøren Laurberg

Professor of SurgeryProfessor of Surgery

Aarhus University HospitalAarhus University Hospital

DenmarkDenmark

MDT I AARHUSMDT I AARHUS

Evolving processEvolving process BackgroundBackground

MR rectumMR rectum Selective 5x5 Selective 5x5

MDT I AARHUSMDT I AARHUS

DECISION MDTDECISION MDT Rectal, recurrent,anal, sarcoma,hipec, Rectal, recurrent,anal, sarcoma,hipec,

rare tumours rare tumours Colonic cancerColonic cancer

FOLLOW-UP MDTFOLLOW-UP MDT INTERNATIONAL MDTINTERNATIONAL MDT

PRIMARY RECTAL PRIMARY RECTAL CANCER-SIMPELCANCER-SIMPEL

CT/MR request, information letter CT/MR request, information letter Letter: date of visit ,pt questionnaireLetter: date of visit ,pt questionnaire 1. visit1. visit

Diagnose ,proctoscopy and notes, Diagnose ,proctoscopy and notes, anaesthesiologistanaesthesiologist

CT- MRCT- MR MDT conference ( 2x week)MDT conference ( 2x week)

2. visit2. visit Treatment planTreatment plan Check listsCheck lists

ENDOSKOPI HorsensENDOSKOPI Horsenssurgery Åthussurgery Åthus

CT og MR oplysninger, endoskopi og CT og MR oplysninger, endoskopi og ASA faxes og tlffASA faxes og tlff

Pt oplyses skriftligt om plan i Århus Pt oplyses skriftligt om plan i Århus – udfylder selvdeklaration– udfylder selvdeklaration

Biopsi svar kirurg anæstesiBiopsi svar kirurg anæstesi Ct-MR-1-2 dageCt-MR-1-2 dage MDT og svarMDT og svar

MDT DECISION MDT DECISION CONFERENCECONFERENCE

↑ ↑ treatment of patientstreatment of patients ↑ ↑ quality of investigationsquality of investigations Better inter and intra disciplinary Better inter and intra disciplinary

collaborationcollaboration Better decisionBetter decision

↑↑teachingteaching

MDT DECISION MDT DECISION CONFERENCE 2 x week 10- CONFERENCE 2 x week 10-

15 cases app. 60 min15 cases app. 60 min Primary RC /Anal cancerPrimary RC /Anal cancer

Treatment planTreatment plan Re-evaluation neo-adjuvant therapyRe-evaluation neo-adjuvant therapy

Stick to the strategy?Stick to the strategy? Recurrent and advanced cancersRecurrent and advanced cancers

See them? , strategy? Progression? See them? , strategy? Progression? Sarcoma, pseudomyxoma rare Sarcoma, pseudomyxoma rare

tumourstumours See them?, strategy?See them?, strategy?

1 IDENTIFICATION OF 1 IDENTIFICATION OF CASECASE

2 PRESENTATION OF 2 PRESENTATION OF CASECASE

COLORECTAL COLORECTAL FELLOWFELLOW

STANDARDISED STANDARDISED PROFORMAPROFORMA

3 PRESENTATION OF CT3 PRESENTATION OF CT

PRESENTATION OF CTPRESENTATION OF CT

CT FIRST- curative, complex or CT FIRST- curative, complex or palliative?palliative?

ONLY CLEAR DECISIONS:ONLY CLEAR DECISIONS: No suspicionNo suspicion MetastasisMetastasis SuspicionSuspicion

Further investigationsFurther investigations Control in 3 monthsControl in 3 months Evaluation by otherEvaluation by other

4 PRESENTATION OF 4 PRESENTATION OF MRMR

PRESENTATION OF MRPRESENTATION OF MR

Follows a proformaFollows a proforma Clear decisionsClear decisions

5 DISCUSSION5 DISCUSSION

Palliative- curativePalliative- curative Neoadjuvant (standard/short Neoadjuvant (standard/short

course+delayed)course+delayed) Direct surgery (PME, Direct surgery (PME,

TME,APE,Evtended)TME,APE,Evtended) Minor treatment (contact,TEM)Minor treatment (contact,TEM) VRAM, brachy, TPE,sacral resectionVRAM, brachy, TPE,sacral resection Complex: involving hepar, lungComplex: involving hepar, lung

6 SUMMARY, 6 SUMMARY, CONCLUSION, ACTIONCONCLUSION, ACTION

LOUD LOUD ANDAND CLEAR CLEAR Decision clear to allDecision clear to all Mistakes are recognizedMistakes are recognized

ActionAction Who is going to see the patient?Who is going to see the patient? Who will contact other departments Who will contact other departments

directly?directly? Time for first visit in oncology decided?Time for first visit in oncology decided?

7. INFORMATION7. INFORMATION

MDT FRIDAY 8-9MDT FRIDAY 8-9 CLINIC AFTER 10CLINIC AFTER 10 DECISION DIRECTLY TO REFERRALDECISION DIRECTLY TO REFERRAL TELEPHONE PTSTELEPHONE PTS

MDT TUESDAY 14-15MDT TUESDAY 14-15 NEXT DAY NEXT DAY DECISION DIRECTLY TO REFERRALDECISION DIRECTLY TO REFERRAL TELEPHONE PTSTELEPHONE PTS

CHECK LISTCHECK LIST

AIMAIM IT IS EASY, FAST AND UNIFORMIT IS EASY, FAST AND UNIFORM WE DO NOT FORGET THINGSWE DO NOT FORGET THINGS WE DOCUMENT THAT PTS ARE WE DOCUMENT THAT PTS ARE

INFORMEDINFORMED

NURSE-RANDOMIZEDNURSE-RANDOMIZEDTRIALTRIAL

Contact nurseContact nurse Case managerCase manager

2.COLON CANCER2.COLON CANCER

SURGEONS –RADIOLOGIST-DAILYSURGEONS –RADIOLOGIST-DAILY Direct surgery-lap?Direct surgery-lap? MDT? CRC?-LIVER?MDT? CRC?-LIVER?

QUALITY CONTROLQUALITY CONTROL

1 hour every second week1 hour every second week Study max 10 cases-rectum and Study max 10 cases-rectum and

coloncolon AIM:AIM:

Quality of MRQuality of MR Quality of surgeryQuality of surgery

Grading CME,PME,TME,APEGrading CME,PME,TME,APE Extend of resectionExtend of resection Cebtral ligation?Cebtral ligation?

INTERNATIONAL MDTINTERNATIONAL MDT

INTERNATIONAL DATABASEINTERNATIONAL DATABASE Advanced recurrent cancerAdvanced recurrent cancer TrialsTrials Observational studiesObservational studies