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Multidisciplinary Management of Rectal Cancer: the OSTRICH

  • Evidence-Based Current Surgical Practice
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Disparity exists in outcomes for rectal cancer patients in the US. Similar problems in several European countries have been addressed by the creation of national networks of rectal cancer centers of excellence (CoEs) that follow evidence-based care pathways and specified protocols of care and process and are certified by regular external validation.

Aim

This paper reviews the current status of rectal cancer care in the US and examines the evidence for multidisciplinary rectal cancer management. A US rectal cancer CoE system based on the existing UK model is proposed.

Methods

A literature search was performed for publications related to US rectal cancer outcomes, multidisciplinary management of rectal cancer, and European rectal cancer programs.

Results

US rectal cancer outcomes are highly variable. The majority of US rectal cancer patients are treated by generalists in low-volume hospitals. Current evidence supports five main principles of rectal cancer care that have been incorporated into European rectal cancer CoE programs. These programs have dramatically improved rectal cancer outcomes in Scandanavian countries and the UK.

Conclusions

A similar CoE program should be established in the US to improve the outcomes of rectal cancer patients.

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Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA

    David W. Dietz

  2. 9500 Euclid Avenue, Desk A-30, Cleveland, OH, 44195, USA

    David W. Dietz

Authors
  1. David W. Dietz
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on behalf of the Consortium for Optimizing Surgical Treatment of Rectal Cancer (OSTRiCh)

Corresponding author

Correspondence to David W. Dietz.

Additional information

CME/MOC Questions

1. Regarding rectal cancer care in the United States, which of the following statements is true?

a. The majority of rectal cancer surgery is performed by specialist surgeons in high-volume hospitals.

b. Less than 20 % of patients with rectal cancer are left with a permanent stoma.

c. Surgeon specialization has been shown to impact the risk for local recurrence, permanent stoma rates, and postoperative mortality.

d. Hospital volume has not been found to impact rectal cancer outcomes.

Answer: c

2. Current evidence supports the adoption of each of the following principles of rectal cancer care EXCEPT:

a. Rectal resection using the technique of “total mesorectal excision”.

b. Abdominoperineal resection for all tumors with 10 centimeters of the anal verge.

c. A multidisciplinary team approach for individualized treatment planning.

d. Measurement of quality of surgery by specific techniques of pathology assessment.

Answer: b

3. The technique of total mesorectal excision is:

a. based on blunt pelvic dissection.

b. unlikely to significantly improve oncologic outcomes.

c. responsible for increasing permanent stoma rates.

d. readily teachable to interested surgeons.

Answer: d

4. Which of the following statements regarding pathology reporting after rectal cancer resection is true?

a. Circumferential resection margin is a weak predictor of risk for local recurrence

b. Tumor (T) stage is the strongest predictor of risk for local recurrence

c. Specialized methods of rectal cancer specimen assessment are of limited value in surgical quality assessment and should be abandoned

d. Mesorectal grading is an important indicator of the quality of surgery

Answer: d

5. MRI-based imaging of rectal cancer can be used to predict each of the following EXCEPT:

a. Tumor (T) stage

b. Nodal (N) stage

c. Mesorectal grade

d. Circumferential resection margin

Answer: c

6. Potential advantages of neoadjuvant radiation therapy in patients with rectal cancer include all of the following EXCEPT:

a. decreased tumor seeding at operation

b. overtreatment of patients with early stage tumors

c. less acute toxicity

d. increased tumor radio-sensitivity

Answer: b

7. Potential disadvantages of neoadjuvant radiation therapy in patients with rectal cancer include:

a. sexual dysfunction

b. altered bowel function

c. need for temporary ileostomy

d. all of the above

Answer: d

8. Implementation of a multidisciplinary team approach to rectal cancer care in several European countries has resulted in each of the following EXCEPT:

a. increased rates of permanent stoma

b. reduced rates of local recurrence

c. greater delivery of evidence based care

d. improved overall survival

Answer: a

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Dietz, D.W., on behalf of the Consortium for Optimizing Surgical Treatment of Rectal Cancer (OSTRiCh). Multidisciplinary Management of Rectal Cancer: the OSTRICH. J Gastrointest Surg 17, 1863–1868 (2013). https://doi.org/10.1007/s11605-013-2276-4

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  • DOI: https://doi.org/10.1007/s11605-013-2276-4

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