Danko Velimir Vrdoljak

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1EDITORIAL Libri Oncol., Vol. 41 (2013), No 1-3, 1MULTIDISCIPLINARY TREATMENT OF COLORECTAL CARCINOMA AND COLORECTAL LIVER METASTASISDANKO VELIMIR VRDOLJAKDepartment of Surgical Oncology, University Hospital for Tumors, University Hospital Center Sestre milosrdnice, Zagreb, CroatiaColorectal carcinoma and colorectal liver me-tastasis are curable by surgery if recognized in an appripriate stage. Nevertheless, multidisciplinary team evaluates and reevalutes patients (diagnos-tics, staging), makes decisions on treatment sched-ule and protocols (neoadjuvant, adjuvant, sur-gery) and is evaluated through pathology reports. Moreover, availability of psychological support and rehabilitation both physical and through the reintegration to society seem essential.In past twenty years considerable improve-ment in treatment of colorectal carcinoma has been recorded. Both through the advencement in surgical technique standards (total mesorectal ex-cision) and in chemoimmunotherapy options. In fact, advanced stages require chemoimmunotherapy,optionally in combination with radiotherapy, as the only possibility that could either control or shrink the tumour thus making it resectable (cur-able). On the other hand surgery has wastly re-duced morbidity and mortality rates in major colorectal and liver metastasis resections. Com-bined with good compliance to screening and timely gastroenterological polyp removal, overall survival from colorectal cancer exceeded 65% in developped countries.Concentrating human recources (specialties) in a few institutions nation wide increses stan-dards of care. Also, viewing cases on multidisci-plinary meetings within such institutions and planing and modifying treatment after review of surgeon, oncologist and radiotherapist, improves the availability and timely access to most appro-priate treatment at the given moment. However, this approach increases the number of treatable patients which has to be taken into account, when estimating the capacity of single institution. One has to consider the possibility of certain care pro-vision on the outpatient basis or under the super-vision of family doctor. Therefore, we believe that information about all aspects of care for colorectal cancer patient should be available.Analysis of current state of treatment of colorectal carcinoma has suggested a need for structured plan of institution stratification accord-ing to services they can provide. Guidelines exist but their implementation and audit seem to be di-vergent. The overall survival rate under 50% in Croatia, requires dealing with this issue and con-sidering even financial analysis of best practice is the cheapest on local level which are now not avail-able.Our efforts aim to the disperse the essential information on current tratment of colorectal can-cer, importance of multidisciplinary approach and information about individual roles in this process and their availability. Hopefully, such dis-persion will increase awareness and stimulate participants in this process, family doctors and epidemiologists, to gain a better perspective and move toward implementation of proven good practices, inevitably reaching our common goal: longer survival and good quality of life during that period.

Multidisciplinary treatment of colorectal carcinoma and colorectal liver metastasis

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