Surgical Management of Advanced Pelvic Cancer

In patients who receive neoadjuvant treatment, response evaluation can be challenging due to the difficulties in distinguishing between malignant and fibrotic changes. Visualizing and assessing complete remission or downsizing of the tumor after neoadjuvant treatment, may alter the surgical planning in highly selected cases the surgical planning. Complete remission after (chemo)radiation cannot be predicted reliably with non‐invasive imaging techniques, because of the spatial limitations to detecting microscopic tumor residue [17]. Even magnetic resonance imaging (MRI) can result in false positive predictions. Addition of diffusion‐weighted imaging (DWI) to standard MRI makes detection more accurate. Overall, an experienced radiologist with considerable expertise is an essential part of the complex cancer MDTM [18–20].

All resected specimens should be examined by an experienced histopathologist and results must be discussed in the complex cancer MDTM. The role of the pathologist includes advanced pelvic cancer specimen quality, lymph node and margin status. Reporting these findings should be done by the use of structured reports [21–22].

All participants should have ample experience with this complex and heterogeneous group of patients. In the case of a treatment plan with curative intent, the surgeon proposes a strategy with as little harm as possible. This proposal often includes induction therapy with chemotherapy, radiotherapy, or both. The medical oncologist and radiation oncologist usually want specific aspects clarified, often involving prior medical history or imaging. The radiologist is frequently asked to specify some aspects of scans that were presented earlier. In cases of non‐curative treatment, the initiative lies with the medical oncologist. The possibilities for enrolment in a clinical trial should be discussed, and when enrolment is possible, the relevant trial will be included in the MDTM outcome advice. The discussion on an individual patient ends with the chair declaring what he or she thinks the consensus of the MDTM is, after which the secretary notes the final conclusion.

Increased complexity of modern cancer care requires a multidisciplinary approach.

Combining the knowledge of different specificities makes the MDTM an excellent learning environment enhance cancer care.

A lack of defined protocols in locally advanced and recurrent pelvic cancer endorses the necessity for a centralized multidisciplinary approach.

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Akash M. Mehta1, David Burling2, and John T. Jenkins1

1 Department of Surgery, Complex Cancer Clinic, St. Mark’s Hospital, London, UK

2 Department of Gastro-Intestinal Radiology, Complex Cancer Clinic, St. Mark’s Hospital, London, UK