The surgeon as a prognostic factor in the surgical treatment of rectal cancer

Gene Expression Differences between Colon and Rectum Tumors

“…It is well known that metastases from colorectal cancer develop in a stepwise process 29 . Rectal cancers usually have a pattern of local recurrence and retrospective studies show a relevant influence of the surgeon on the prognosis of these patients 30 . For colon cancers, the progression pattern is more typically characterized by liver metastases, potentially explained by the fact that superior mesenteric vein drains the right colon whereas neither the left colon nor the rectal vasculature directly drains to liver 29 .…”

A nationwide audit of the use of radiotherapy for rectal cancer in Italy

“…In defining high-volume centers, we have adopted a previously used cut-off of 30 patients [27]. In the literature, there is no consensus on the number of cases per center per year to define high-volume centers, the numbers vary from 6 to 50 [28]. In a study limited to elderly patients, Rogers et al already observed that high-volume centers were more likely to use radiotherapy for rectal cancer but did not separate pre from postoperative [29].…”

“…Some have proposed to identify a subgroup of high-risk patients (males with low lying cancers) that are more likely to benefit from a high-volume cancer care center [31]. But at least in Europe, the superiority of high-volume centers in delivering expert rectal cancer management is based on inconsistent evidence [28,32]. It is however necessary for future studies to take into account the mode of radiotherapy delivery as this has been shown to significantly impact local recurrence and survival [33].…”

Standardisation and outcomes audit: a step forward in surgical oncology

“…Moreover, it is well known that fl aws in the primary surgical resection of a malignant tumour imprint a negative impact on diseasespecifi c survival that cannot be overcome by complementary cancer therapy delivered at a later time. The surgeon has been identifi ed as a signifi cant prognostic factor in malignant disease [1], and the crucial responsibility of surgeons in the ultimate outcome of their cancer patients cannot be overemphasised.However, it is well known that variations in surgical practice and outcomes occur between countries and within different regions of a given country [2]. Acknowledging these variations in such a central component of cancer treatment may leave us with a legitimate concern on how adequate the treatment of patients at a certain point of care may be.…”

“…Moreover, it is well known that fl aws in the primary surgical resection of a malignant tumour imprint a negative impact on diseasespecifi c survival that cannot be overcome by complementary cancer therapy delivered at a later time. The surgeon has been identifi ed as a signifi cant prognostic factor in malignant disease [1], and the crucial responsibility of surgeons in the ultimate outcome of their cancer patients cannot be overemphasised.…”