Specialization improves outcomes in rectal cancer surgery

Wolford, Dallas D.; Westcott, Lauren Zammerilla; Fleshman, James W.

doi:10.1016/j.suronc.2022.101740

Cited by 5 publications

(4 citation statements)

References 48 publications

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“…21 In addition, well-accepted and important quality indicators for rectal cancer treatment, such as lymph node yield, adherence to evidence-based guidelines, accuracy of clinical staging, colostomy rates, and circumferential resection margin status have been found to be substandard. 22 The current state of US rectal cancer care is similar to care that existed 20 years ago in several European countries. National efforts to improve the quality of care through provider training, followed by consolidation and standardization of care, have decreased local recurrence rates by ~50% and raised 5-year survival rates by up to 60% in Sweden, Norway, the Netherlands, and Denmark.…”

Section: Current and Future Of Rectal Cancer Care In The United Statesmentioning

confidence: 96%

“…Examination of the Commission on Cancer’s National Cancer Database, which captures ~70% of all invasive cancer cases treated annually in the United States, reveals that most patients with rectal cancer are cared for in low-volume hospitals by nonspecialist providers 21. In addition, well-accepted and important quality indicators for rectal cancer treatment, such as lymph node yield, adherence to evidence-based guidelines, accuracy of clinical staging, colostomy rates, and circumferential resection margin status have been found to be substandard 22…”

Section: Current and Future Of Rectal Cancer Care In The United Statesmentioning

confidence: 99%

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Improving Value in Surgery

et al. 2022

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Section: Current and Future Of Rectal Cancer Care In The United Statesmentioning

confidence: 96%

Section: Current and Future Of Rectal Cancer Care In The United Statesmentioning

confidence: 99%

Improving Value in Surgery

et al. 2022

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“…Given this study was conducted over a 15-year period, this suggests a total hospital volume of 3-4 rectal cancer operations per year. There are now considerable data showing that volume matters in the management of rectal cancer, 4 with recent NICE guidelines summarizing these and recommending a minimum annual volume of 10 rectal cancer resections per hospital and 5 per surgeon to maintain competency. 5 Closer to home, NSW health has recently designated rectal cancer specialist centres, with a suggested minimum volume of 12 rectal cancer resections annually.…”

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confidence: 99%

Re: outcomes of laparoscopic colorectal cancer surgery in a non‐metropolitan Australian hospital

Sammour

Hunter

2023

ANZ Journal of Surgery

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“…[4][5][6] The colorectal community must be cautious as to what message is delivered to general providers. 7 Escalating neoadjuvant therapies is not the solution to poor surgical technique.…”

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confidence: 99%

Good Medicine Does Not Compensate for Bad Surgery

Goffredo,

Allievi,

Koh

et al. 2023

Diseases of the Colon &Amp; Rectum

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To the Editor-High-quality total mesorectal excision (TME), as popularized by Professor Heald, is the cornerstone in the treatment of rectal cancer. 1 Although neoadjuvant therapy may further supplement TME benefits, it cannot be considered a substitute and diminish the importance of specimen quality. 2 This consideration is important to keep in mind when reviewing the data presented by Garoufalia et al, 3 who reported incomplete TME in 17% of 124 patients with comparable local recurrence rates to the complete group (6.25% vs 7.4%). This finding led to the conclusion that TME quality may be less relevant in the era of "extensive neoadjuvant treatment. " However, neither data on tumor biology nor clear comparisons between the groups were presented, raising questions about biases, heterogeneity of patients, and methodology. Furthermore, the higher rates of metastases for incomplete TME (37.5% vs 22.2%) suggest that an outcome difference is likely given larger samples with longer follow-up.Hence, the statement regarding the low value of complete TME in the setting of multidisciplinary treatment should be carefully interpreted. Only 14% received total neoadjuvant therapy and 71% underwent chemoradiotherapy alone, whereas 20% had stage I and 10% had high cancers. Therefore, this cohort did not truly represent "extensive neoadjuvant treatment. " In line with previous trials, RAPIDO redemonstrated the contemporary importance of specimen quality as the experimental arm had lower complete TMEs (66% vs 85%; p = 0.048) and higher recurrence rates. [4][5][6] The colorectal community must be cautious as to what message is delivered to general providers. 7 Escalating neoadjuvant therapies is not the solution to poor surgical technique.

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Specialization improves outcomes in rectal cancer surgery

Cited by 5 publications

References 48 publications

Improving Value in Surgery

Improving Value in Surgery

Re: outcomes of laparoscopic colorectal cancer surgery in a non‐metropolitan Australian hospital

Good Medicine Does Not Compensate for Bad Surgery

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