For so many years, abdominoperineal excision has been the mainstay of surgical treatment for rectal cancer 7 cm and below the anal verge. With continued research and introduction of new technology, the management of rectal malignancies has involved making it possible to save the sphincter complex mechanism despite the distance from the verge. Concurrent with these developments is the introduction of a multidisciplinary team approach which the UP-Philippine General Hospital Colorectal Division has adopted in managing colorectal cancer cases. With the adoption of these advancements in the management of patients with rectal cancer, it is surmised that the institution's APR rates have decreased.

OBJECTIVES: The study aimed to document and compare the abdominoperineal resection (APR) rates at the Philippine General Hospital (PGH), before and after the introduction of a multidisciplinary team for colorectal cancer, over the course of 5 years (2005-2009).

METHODS: The study included all adult patients undergoing resection for low to mid rectal cancer, described as a tumor with distal extent of 11 cm or below from the anal verge (FAV), from January 1, 2005 to December 31, 2009. Data pertinent to the management were gathered. Frequencies and rates before and after the introduction of a multidisciplinary team approach were computed and compared.

RESULTS: There were a total of 230 rectal resection for cancer over a five-year period. The patients' mean age was 53 years (range: 26 to 83). There were 122 males and 108 females. Almost half of the patients (48.7%) presented with a clinical stage of Stage IIIB. Forty-three percent of patients underwent either pre-operative radiotherapy or combined chemoradiotherapy. Cumulatively, the APR rate was 30.90 percent (sphincter-saving rate 69.10%) The APR rate for 2009 was 12.82 percent (sphincter-saving rate 87.18) corresponding to a 39.18 percent decrease in APR rate from the highest APR rate recorded in 2006 (52%).

CONCLUSION: A multidisciplinary team (MDT) approach resulted in lower APR rates among patients with rectal cancer at the UP-PGH.

Human ; Aged 80 And Over ; Aged ; Middle Aged ; Colorectal Neoplasms ; Hospitals, General ; Philippines ; Rectal Neoplasms ; Rectum ; Chemoradiotherapy ; Digestive System Surgical Procedures ; Patient Care Team

OBJECTIVE: The paper aimed to described and document the multidisciplinary process being ascribed to in the care of the colorectal cancer patient at the UP-PGH as conducted by the UP-PGH Colorectal Cancer and Polyp Study Group.

METHODS: A description of the multidisciplinary team (MDT) process is presented. Data supplementing the documentation of the MDT process were, likewise, presented.

RESULTS: In 2008, 214 rectal cancer patients were admitted and managed by the Division of Colorectal Surgery. Of these, 52 patients with mid- to low-rectal tumors eventually underwent resection of the primary lesion. Forty-one (79%) underwent a sphincter-saving operation. Only 11 APRs were performed. Our APR rate was, thus, at 21 percent. Among the 52 patients, 18 underwent neoadjuvant treatment with 10 subjected to chemoradiotherapy prior to surgery, a pathologic complete response was observed in 4 patients.

CONCLUSION: With the increasing incidence of colorectal malignancies and the continuing collection of evidence supporting multimodality approach, the role of multidisciplinary team in the management of these cancers has come to the fore. UP-PGH Colorectal Cancer and Polyp Study Group has shown that the multidisciplinary team approach may be implemented amidst institutional and financial limitations without compromising the delivery of quality and efficacious cancer management.

Human ; Colorectal Neoplasms ; Neoadjuvant Therapy ; Colorectal Surgery ; Rectal Neoplasms ; Chemoradiotherapy ; Colonic Neoplasms ; Polyps ; Patient Care Team

A rare case of right sided diaphragmatic hernia, in a 49 year-old male with a history of penetrating right chest trauma thirty years prior to consultation, is reported. The salient features of the successful management of this patient, presenting with signs and symptoms of complete intestinal obstruction, is described. The natural history of diaphragmatic hernias is reviewed.

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