Wexner Steven D, Berho Mariana E
1 Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida 2 Department of Pathology and Laboratory Medicine, Cleveland Clinic Florida, Weston, Florida.
Dis Colon Rectum. 2017 Jun;60(6):595-602. doi: 10.1097/DCR.0000000000000840.
The treatment of rectal cancer has greatly evolved because of numerous diagnostic and therapeutic advances. More accurate staging by MRI has allowed more appropriate use of neoadjuvant therapy as well as more standardized high-quality total mesorectal excision. Lower rates of perioperative morbidity, permanent colostomy creation, and improved rates of oncologically acceptable rectal excision have led to lower recurrence and greater disease-free survival rates. The recognition of the need for pathologic assessment of the quality of total mesorectal excision, the status of the circumferential resection margins, and the finding of a minimum of 12 lymph nodes as well as identification of extramural vascular invasion has improved staging. These evolutions in imaging, surgical management, and pathologic specimen assessment are interdependent and have been repeatedly shown on national levels to be best operationalized in a multidisciplinary team environment.
The aim of this article is to evaluate the evidence leading to these important changes, including the imminent launch of the National Accreditation Program for Rectal Cancer.
Based on the myriad confirmatory experiences in Europe and in the United Kingdom, a multidisciplinary team rectal cancer program was designed by the Consortium for Optimizing Surgical Treatment of Rectal Cancer and subsequently endorsed and accepted by the American College of Surgeons Commission on Cancer.
The primary outcome measured is the adherence to the new program standards.
Surgical treatment of rectal cancer consortium membership rapidly increased from 14 centers in August 2011 to more than 350 centers in April 2017.
The multidisciplinary team rectal cancer program has not yet launched; thus, its impact cannot yet be assessed.
It is our hope and expectation that the outstanding improvement in quality outcomes repeatedly demonstrated within Europe, and extensively shown as much needed in the United States, will be rapidly achieved.
由于众多诊断和治疗方面的进展，直肠癌的治疗有了很大的发展。磁共振成像（MRI）实现了更准确的分期，从而能够更合理地使用新辅助治疗，并使全直肠系膜切除术更加标准化、高质量。围手术期发病率、永久性结肠造口术的发生率降低，以及肿瘤学上可接受的直肠切除率提高，导致复发率降低和无病生存率提高。对全直肠系膜切除质量的病理评估、环周切缘状态的认识，以及发现至少12个淋巴结和识别壁外血管侵犯，改进了分期。这些成像、手术管理和病理标本评估方面的进展相互依存，并且在国家层面反复表明，在多学科团队环境中实施效果最佳。
本文旨在评估促成这些重要变化的证据，包括即将推出的国家直肠癌认证计划。
基于欧洲和英国的大量确凿经验，直肠癌优化手术治疗联盟设计了一个多学科团队直肠癌项目，随后得到了美国外科医师学会癌症委员会的认可和接受。
所测量的主要结果是对新项目标准的遵守情况。
直肠癌手术治疗联盟的成员从2011年8月的14个中心迅速增加到2017年4月的350多个中心。
多学科团队直肠癌项目尚未启动；因此，其影响尚无法评估。
我们希望并期待，在欧洲反复证明的质量结果方面的显著改善，以及在美国广泛显示出的迫切需求，将迅速实现。
