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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Footnotes
☆(Presentation given by W. C. Cirocco, M.D.)
Identification
Copyright
© 2018 Published by Elsevier Inc.