Practice patterns for complex situations in the management of rectal cancer: A multidisciplinary inter-group national survey.

Summary Goal To report the current clinical practice of French physicians for rectal cancer in various complex settings. Methods Nineteen clinical situations and four surveillance modalities were proposed to a panel of experts via 11 learned societies. The answers of 48 experts and the impact of colorectal specialists on therapeutic options were compared to those of other participants. Results A total of 722 physicians [surgeons = 319 (44%), gastro-intestinal oncologists = 305 (42%), radiotherapists = 98 (14%)] participated in this study. The mean number of answers per question was 500. A consensus was reached in 19 clinical situations. Approaches according to specialty were similar in most situations. In seven settings, the therapeutic strategy differed significantly (interval between the end of chemo-radiation and surgery, attitude based on response of neo-adjuvant therapy, treatment of usT1N0 or pT1sm2 tumors after endoscopic resection, adjuvant therapy for pT3N1 tumors, interval to protective stoma closure, and schedule of follow-up surveillance). There was disagreement between experts and non-experts with regard to three management plans (contra-indications for neo-adjuvant chemo-radiation therapy, strategy according to response to neo-adjuvant therapy, and date of protective stoma closure). Conclusion This survey provides an overview of current practice of a selected group of French physicians. Sound knowledge of the current literature and case-by-case discussion with a group of experts from each involved specialty during a multidisciplinary conference are essential. Certain complex cases should be presented to expert centers to validate the therapeutic approach.