The Impact of LOREC on Rectal Cancer Management in ...€¦ · •Low Rectal Cancer National Development Programme •Launched in October 2010 •Four main elements: 15 LOREC workshops

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?