1. Quality and Organization of Care Value of a Multidisciplinary Team (MDT) Brendan Moran 15 th February 2011

6. Why Rectal Cancer ?

10. “ All patients with colorectal cancer should be managed in a hospital with a colorectal MDT”

12. “ No decisions about me without me” ??

16. <6cm 12-15 cm - upper Definitions of upper, middle and low rectal cancer 7-11 cm – middle

17. Anterior resection Most Permanent stoma Except specialist units ? And slightly higher ! <6cm 7-11 cm 12-15cm Restorative anterior resection Rectal Excision For Cancer

21. “ The MDT” Basingstoke 1980’s

22. “ The MDT” Basingstoke 1980’s

23. “ The MDT” Basingstoke 1980’s

25. The rectal cancer story

28. Phil Quirke –Subset analysis Quality and p lane of surgery MRC CR07 n=1119 Mesorectal Intra-mesorectal Muscularis propria n=596 53% n=382 34% n=141 13%

29. Disease free survival by plane of surgery 72% 79% (p=0.29)

31. Pelican (Pelvic and liver cancer) Centre Basingstoke The M.E.R.C.U.R.Y. Study M agnetic RE sonance Imaging and R ectal C ancer E UR opean Equivalence Stud Y

32. MERCURY - MRI and The Concept

38. pT3, pN2 and baby 20 weeks later

39. 2006  2010

45. Upper Rectal Low rectal

49. Side-effects preoperative radiotherapy: Lange MM Br J Surg 2007 P <0.001 Faecal incontinence

54. “ Parachutes reduce the risk of injury after gravitational challenge, but the effectiveness has not been proven with randomized controlled trials” MDT

57. Surgery alone Group -178/259 (69%)

59. Team- work Crucial