T1 Rectal Cancer Management - The ERC Study

Rectal cancer is common, with an annual incidence of 14,000 new cases per annum in the UK, with early, stage I disease presenting in approximately 17% of patients. The traditional treatment of all resectable rectal cancer is surgical resection, however there has been an increased trend to organ preservation. There are a variety of endoscopic and surgical options available for local excision of a T1 rectal cancer, which have been shown to have oncologically equivalent outcomes, with some conflicting reports with regards to local recurrence rates. 

The National Bowel Cancer Audit Report 2016 states that only 7% in the UK and 2% of patients in the North East with rectal cancer are definitively managed with local excision. Given the small number of potentially eligible patients for the treatment of local excision combined with the small number of patients currently being offered this treatment in the North East, we are conducting a regional project to formally document the variation in practice of T1 rectal cancers in the North East, including the current methods of local excision techniques offered with associated short-term and medium-term oncological outcomes.

This study has been designed as a two-phase study, the first phase will be an organisational survey to identify treatment pathways for early rectal cancer. The second phase will be a retrospective, multi-centre, observational cohort-study of all patients with a T1 rectal cancer. 

The study will take place across all colorectal and gastrointestinal units across the North East of England between 2010 and 2017. This will provide us with a contemporary dataset. 

All patients who have received endoscopic or surgical treatment of a T1 (as per pathology reports) rectal cancer will be included. Based on extrapolated local data we estimate approximately 700 cases. This based on a local unit treating approximately 11 cases in 1 year and capturing data from all colorectal units across the region over a seven-year period. The catchment population for the North East is 3.1 million. 

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michael jones,
4 Mar 2018, 03:32