2nd Pelican Annual Workshop Seminar - Programme
The multi-disciplinary approach to rectal cancers below 6cm
Thursday 18 November 2004
07.50 Transport from Apollo/Centrecourt Hotels to Pelican Centre
08.00 – 08.30 Registration
08.35 Welcome Mr Chris Beagley,
CEO Pelican Cancer Foundation
08.40 – 09.05 INTRODUCTION: Mr Brendan Moran
Chairs: Prof. Chummy Sinnatamby Mr Brendan Moran
Dr Joachim Strassburg
0840 ‘So many questions, so little time!’ Prof. Bill Heald
0850 ‘APE in evolution’ Prof. John Nicholls
09.05 – 10.40 ANATOMY of the DISTAL RECTUM and MESORECTUM, the LEVATORS and the UROGENITAL SEPTUM (Fascia of Denonvillier)
0905 The distal rectum and mesorectum through the ‘video eyes’ of the abdominal surgeon Prof. Bill Heald
0915 The perineal aspect Prof. John Nicholls
0925 Low rectal cancer anatomy through the eyes of an academic anatomist
Prof. V Mahadavan
0940 MRI anatomy of the levators, distal rectum and mesorectum, and the anal canal in relation to cancer Dr Gina Brown
0955 The nerves of sexual function through the eyes of the urologist
Mr Chris Eden
1010 The development of the recto-genital septum, the recto anal region and the pelvic floor Dr Helga Fritsch
1025 Discussion
10.45 – 11.10 Coffee
11.15 – 11.25 2 CASE REPORTS
Chair: Prof. Bill Heald
Two overseas referrals to ponder on during the meeting
1115 Case 1. ‘So many second opinions’ Mr Matthew Croxford
1120 Case 2. ‘The new world of neo adjuvants and their impact on surgery’
Ms Gisella Salerno
Discussion deferred until a later session
11.30 – 13.00 THE FIRST PRE-OPERATIVE MDT MEETING – Current Decision Making
Chairs: Dr Johan Wiig
Prof. Werner Hohenberger
Mr Ian Swift
Dr Delia Peppercorn
‘MRI, THE PROBE and THE FINGER’
STAGING for a) HEIGHT
b) THREAT to the CIRCUMFERENTIAL MARGIN
1130 MRI – ‘state of the art’. Staging by MRI with particular reference to the low cancer Dr Gina Brown
1140 E R U S – Endorectal ultrasound is STILL the best for certain cancers
Mr Darren Gold
1150 THE FINGER is still needed to assess the HEIGHT
Prof. Bill Heald
1155 AR or APE? The surgeon must have the last word
Prof. Werner Hohenberger
1210 Changes in tumour tissue after neo adjuvant therapy Prof. Christian Wittekind
PRE-LUNCH LECTURE
1225 ‘RADIOTHERAPIE – PRÊT Á PORTER OU SUR MESURE?’
‘Tailored approach to pre op irradiation’
Prof. Jean Pierre Gerard
1250 Discussion
13.00 – 14.00 Lunch
14.00 – 17.50 LIVE SURGERY with Fibre Optic VIDEO LINK and two way discussion
Chairs: Prof. Bill Heald
Prof. David Rothenberger
Prof. Werner Hohenberger
Presentation of the cases Mr Matthew Croxford
Ms Gisella Salerno
The MRI’s Dr Delia Peppercorn
MDT discussion with the visiting teams – would you have made the same decisions?
1. ABDOMINO – PERINEAL EXCISION
Laparoscopic abdominal dissection
Prof. Antonio Lacy Mr Mark Gudgeon Mr Tom Cecil
Cylindrical perineal dissection
Dr Torbjorn Holm Mr Darren Gold
2. ULTRA LOW ANTERIOR RESECTION and POUCH to ANUS Triple stapled ANASTOMOSIS
Mr Brendan Moran
Prof. Bill Heald
The MRI ‘Route Map’ during surgery. Dr Delia Peppercorn
Dr Gina Brown
18.00 Transfer to the Apollo Hotel
18.30 Drinks reception
19.30 Dinner at the Apollo
Pre-dinner, address and questions by Professor Mike Richards, the National Cancer Director.
Post- dinner, Mr Michael Crumplin, SURGERY DURING THE NAPOLEONIC WAR.
23.00 Transfer to the Centrecourt Hotel
Friday 19 November 2004
07.50 Transport from Apollo/Centrecourt Hotels to Pelican Centre
08.30 – 09.35 HISTOPATHOLOGY and AUDIT
PRE OPERATIVE THERAPY IS REVOLUTIONISING OUR STAGING SYSTEMS
Chairs: Prof. Soren Laurberg Prof. Roger Motson
Dr Gina Brown
0830 The ACGBI reporting of margin involvement Mr Jeff Stamatakis
0840 The National Minimum Dataset Prof. Geraint Williams
0855 Some current areas of controversy Prof. Phil Quirke
Topics to include:
ypT reporting
Don’t forget the distal margin
Margin and T3 reporting – ‘millimeters are best’
The APE Specimen – what we learned last year - towards better APE’s
0920 Discussion
09.30– 10.25 LOOKING TO THE FUTURE OF ADJUVANT THERAPY
Chairs: Prof. David Rothenberger
Dr David Sebag-Montefiore
Prof. J P Gerard
0930 THE GERMAN TRIAL OF CHEMO/RT BEFORE or AFTER
Prof. Werner Hohenberger
0945 CURRENT COMBINATIONS IN CHEMO/RADIOTHERAPY
Dr David Sebag-Montefiore
1000 The MERCURY STUDY – THE TEMPLATE for THE FUTURE
Mr Ian Daniels
1015 Discussion
10.25 – 10.50 Coffee
10.55 – 12.15 CAN CONFORMAL RT IMPROVE PRESERVATION OF SPHINCTER FUNCTION?
Chairs: Dr David Sebag-Montefiore
Dr Diana Tait
Dr Geoff Sharpe
Scandinavian Corner
1055 Short course RT – Answering its critics Dr Torbjorn Holm
1105 Total Mesorectal Irradiation – A Danish Tale Prof. Claus Bisgaard
Current British Concepts
1115 The potential of conformal RT in the pelvis – must RT make the patient sterile? Dr Geoff Sharpe
1125 Can chemo facilitate smaller RT dosage and thus better function?
Dr David Sebag-Montefiore
1135 THE ROYAL MARSDEN APPROACH to conformal RT
Dr Diana Tait
1150 Discussion – to include the 2 cases briefed earlier
12.20– 12.55 THE BILL HEALD LECTURE Chair: Mr Brendan Moran
Decision making: APE, AR or Local Excision - the current American view
Prof. David Rothenberger
1255 Discussion
13.00 – 14.00 Lunch
14.00 - 16.00 SURGICAL FORUM
Chairs: Prof. Jack Hardcastle
Mr Brendan Moran
1400 USE OF FLAPS IN LOW RECTAL CANCER SURGERY
Dr Soren Laurberg
1415 MUST EVERY ‘LOW’ CANCER HAVE RT? Dr Johan Wiig
1430 THE LAPAROSCOPIC METHOD Prof. Antonio Lacy
1445 THE DUTCH TME TRIAL – ‘The spin-offs and pointers to the future’
Dr Gerard Beets
1500-1600 SOME HOT TOPICS Discussion to be led by: Prof. Bill Heald
1. The ‘holy plane’ for laparoscopists Prof. Bill Heald
Some words of caution Dr Werner Hohenberger
2. The impact of RT on tbd
a) healing of anastomoses
b) the perineal wound
c) function
3. Downstaging
Dare we cut through tissue formerly involved by tumour? tbd
4. The temporary stoma
When should it be closed – before or after chemo? tbd
Can the medical oncologist shorten the chemotherapy?
Dr David Sebag-Montefiore
5.The low anastomosis
Triple stapling Mr Brendan Moran
Transanal manual with the Lone Star retractor Mr Darren Gold
6. APE Techniques - Position on the table tbd
Prone jacknife
The ‘Berlin Position’ Dr Joachim Strassburg
Finale
(Date of amendment 14.09.04)
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