SP 3.17 A Multicentre Audit Comparing Decision-Making Across Welsh Multidisciplinary Teams for Newly Diagnosed Rectal Cancer

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ID: 323979
2026
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Abstract
Abstract Introduction Rectal cancer management is increasingly complex due to expanding neoadjuvant and adjuvant options, including total neoadjuvant therapy (TNT), organ preservation, and immunotherapy. While these advances may improve outcomes, they risk introducing inter-centre variation between, raising concerns about equity. This audit evaluated rectal cancer management across Welsh multidisciplinary teams (MDTs), explored inter-centre variation, and aimed to inform future pathway alignment. Methods Prospective data were collected during MDT meetings over one month using a standardised electronic form. Data captured the first definitive MDT discussion for rectal cancer patients, including tumour stage, anatomical level, circumferential resection margin (CRM) and extramural venous invasion (EMVI) status, MSI status, performance status, and planned management. Decisions regarding neoadjuvant therapy, radiotherapy, surgical intent, and organ preservation were recorded. Patient outcomes were not assessed. Results Fifty-seven cases were recorded across seven centres. TNT was recommended in 21 cases, mainly for T3/4 tumours with nodal disease, EMVI positivity, or threatened CRM. Use of short-course radiotherapy varied markedly between centres, while long-course radiotherapy was more commonly used in frail patients with mid or low rectal tumours. Eleven patients were managed with organ preservation intent. MSI status was frequently pending at decision-making, with inconsistent documentation of its influence. Management of high-risk T3 tumours varied between TNT and upfront surgery. Conclusion Welsh MDT decision-making was broadly guideline-aligned but demonstrated variation in radiotherapy strategy, TNT use, organ preservation, and low rectal tumour management. These findings support further pathway alignment across the network, particularly in anticipation of AI-supported MDTs and emerging colorectal cancer biomarkers.
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openalex_W7172530120 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Dominic Thompson
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.048
URL
https://doi.org/10.1093/bjs/znag087.048
Keywords Keywords not found

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