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Clinical competence in the surgery of rectal cancer

July's publication of the International Journal of Colorectal Disease summarizes the findings of the Italian Consensus Conference in rectal cancer surgery.

News image

The literature continues to emphasize the advantages of treating patients in “high volume” units by “expert” surgeons, but there is no agreed definition of what is meant by either term.

In September 2012, a Consensus Conference on Clinical Competence was organized in Rome as part of the meeting of the National Congress of Italian Surgery.

Dr Piccoli Micaela and colleagues provide feedback on the consensus conference.

The team report that the aims were to provide a definition of “expert surgeon” and “high-volume facility” in rectal cancer surgery and to assess their influence on patient outcome.
The review team encountered difficulties in defining competence in rectal surgery
International Journal of Colorectal Disease

An Organizing Committee, a Scientific Committee, a Group of Experts, and a Panel/Jury were set up for the conduct of the Consensus Conference.

The team reviewed the literature and focused on 3 main questions including training, “measuring” of quality, and to what extent hospital and surgeon volume affects sphincter-preserving procedures, local recurrence, 30-day morbidity and mortality, survival, function, choice of laparoscopic approach, and the choice of transanal endoscopic microsurgery.

The team noted the difficulties encountered in defining competence in rectal surgery arise from the great heterogeneity of the parameters described in the literature to quantify it.

Dr Micaela's team comments, "Acquisition of data is difficult as many articles were published many years ago."

"Even with a focus on surgeon and hospital volume, it is difficult to define their role owing to the variability and the quality of the relevant studies."

Int J Colorectal Dis 2014: 29(7): 863-875
04 July 2014

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