Kler A; Countess of Chester Hospital NHS Foundation Trust, UK
Tay J; Slawinski C; Welch C; Moug S; et al

Annals of the Royal College of Surgeons of England. 108(6):430-437, 2026 Jul.

INTRODUCTION: Surgical resection is the main treatment for non-metastatic
colorectal cancer (CRC). However, 6% of patients do not undergo surgery
owing to frailty, according to the National Bowel Cancer Audit (NBOCA).
The impact of preoperative evaluation and decision making on outcomes in
frail patients is underexplored. This study examines variation in decision
making for frail, older patients and the availability/use of resources by
colorectal multidisciplinary teams (MDTs) across United Kingdom (UK)
hospitals.

METHODS: A UK-wide questionnaire was distributed to colorectal MDTs via
the NBOCA newsletter and social media (18 May to 30 June 2021). Part A
assessed MDT structure and resource use; Part B explored MDT decisions for
two simulated 75-year-old patients with colonic and rectal cancer.

RESULTS: Twenty MDTs responded. Decisions were MDT-driven in 55% (n = 11)
and surgeon-driven in 45% (n = 9). Clinical examination (85%) and
performance status (90%) were most used. Resource utilisation during MDT
meetings varied across sites; for example, echocardiogram results were
available and considered in MDT decision making in only 15% of centres.
Cardiopulmonary exercise testing was used in 75%, anaesthetic assessment
in 80%, frailty scoring in 25%, and preoperative geriatric assessment in
5%. Management of right-sided cancer was more consistent; rectal cancer
decisions were more variable.

CONCLUSIONS: Variation exists across MDTs in the availability and use of
resources when managing frail CRC patients. There is less consensus for
rectal than caecal cancer. These findings highlight the need for
standardised MDT