Rectal resection following neoadjuvant therapy in a midwest community hospital setting: The case for standardization over centralization as the means to optimize rectal cancer outcomes in the United States

        DR. MICHAEL A. VALENTE (Cleveland, Ohio): You should be congratulated for this very timely and important study in the field of rectal cancer outcomes and quality. The issue of centralization over specialization is a critical topic right now, and we are in the midst of a review by the NAPRC under the auspices of the American College of Surgeons Committee on Cancer, and this was happening at our institution just a few weeks ago. The NAPRC's goal is to improve the quality of rectal cancer care by standardizing treatment, not necessarily centralizing treatment. Multiple standards do exist, but the key components which I'll review are the role of the multidisciplinary team, including pathology, radiology, colorectal surgery, radiation medical oncology, having regularly scheduled tumor boards having well performed synoptic reporting by both the radiologists and the pathologists, and, of course, intraoperative quality metrics, including circumferential resection margin and other margin status related to the TME. This paper displays what a single high volume surgeon can achieve in a relatively low volume institution in geographical areas where there may not be subspecialty care. I do have some questions. I will limit them to three.
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