How Do We Audit Rectal Cancer Treatment: The EURECCA Perspective

  • Anne J. Breugom
  • Cornelis J. H. van de Velde


Randomised controlled trials (RCTs) are considered as the gold standard for determining treatment efficacy. Moreover, the effectiveness of quality control in surgery, radiotherapy, and pathology has been showed in the Dutch TME trial. McArdle and Hole stated in the early 1990s that “some surgeons perform less then optimal surgery; some are less competent technically than their colleagues; and some fail to supervise surgeons in training adequately... If by more meticulous attention to detail the results of surgery could be improved, and our results suggest that this would not be difficult, the impact on survival might be greater than that of any of the adjuvant therapies currently under study” [1].


  1. 1.
    McArdle CS, Hole D (1991) Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival. BMJ 302(6791):1501–1505CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Guren MG, Korner H, Pfeffer F et al (2015) Nationwide improvement of rectal cancer treatment outcomes in Norway, 1993–2010. Acta Oncol 54:1–9. [Epub ahead of print]CrossRefGoogle Scholar
  3. 3.
    Bulow S, Harling H, Iversen LH, Ladelund S (2010) Improved survival after rectal cancer in Denmark. Colorectal Dis 12(7 Online):e37–e42PubMedGoogle Scholar
  4. 4.
    Pahlman L, Bohe M, Cedermark B et al (2007) The Swedish rectal cancer registry. Br J Surg 94(10):1285–1292CrossRefPubMedGoogle Scholar
  5. 5.
    National Bowel Cancer Audit Report (2014) Accessed July 2015
  6. 6.
    Jannasch O, Udelnow A, Romano G et al (2014) International quality assurance project in colorectal cancer-unifying diagnostic and histopathological evaluation. Langenbeck's Arch Surg 399(4):473–479CrossRefGoogle Scholar
  7. 7.
    Jegou D, Penninckx F, Vandendael T, Bertrand C, Van EE (2015) Completeness and registration bias in PROCARE, a Belgian multidisciplinary project on cancer of the rectum with participation on a voluntary basis. Eur J Cancer 51(9):1099–1108CrossRefPubMedGoogle Scholar
  8. 8.
    Codina-Cazador A, Espin E, Biondo S et al (2007) Audited teaching program for the treatment of rectal cancer in Spain: results of the first year. Cir Esp 82(4):209–213CrossRefPubMedGoogle Scholar
  9. 9.
    Gietelink L, Henneman D, van Leersum NJ et al (2014) The influence of hospital volume on circumferential resection margin involvement: results of the Dutch surgical colorectal audit. Ann Surg 260(3):504–508CrossRefGoogle Scholar
  10. 10.
    Messenger DE, McLeod RS, Kirsch R (2011) What impact has the introduction of a synoptic report for rectal cancer had on reporting outcomes for specialist gastrointestinal and nongastrointestinal pathologists? Arch Pathol Lab Med 135(11):1471–1475CrossRefPubMedGoogle Scholar
  11. 11.
    Quirke P, West NP, Nagtegaal ID (2014) EURECCA consensus conference highlights about colorectal cancer clinical management: the pathologists expert review. Virchows Arch 464(2):129–134CrossRefPubMedGoogle Scholar
  12. 12.
    Maniar RL, Hochman DJ, Wirtzfeld DA et al (2014) Documentation of quality of care data for colon cancer surgery: comparison of synoptic and dictated operative reports. Ann Surg Oncol 21(11):3592–3597CrossRefPubMedGoogle Scholar
  13. 13.
    Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1(8496):1479–1482CrossRefPubMedGoogle Scholar
  14. 14.
    van Gijn W, Marijnen CA, Nagtegaal ID et al (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12(6):575–582CrossRefPubMedGoogle Scholar
  15. 15.
    Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M (2006) Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 93(10):1215–1223CrossRefPubMedGoogle Scholar
  16. 16.
    Birkmeyer JD, Siewers AE, Finlayson EV et al (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346(15):1128–1137CrossRefPubMedGoogle Scholar
  17. 17.
    Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J et al (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49(6):1374–1403CrossRefPubMedGoogle Scholar
  18. 18.
    Breugom AJ, Boelens PG, van den Broek CB et al (2014) Quality assurance in the treatment of colorectal cancer: the EURECCA initiative. Ann Oncol 25(8):1485–1492CrossRefPubMedGoogle Scholar
  19. 19.
    van de Velde CJ, Aristei C, Boelens PG et al (2013) EURECCA colorectal: multidisciplinary mission statement on better care for patients with colon and rectal cancer in Europe. Eur J Cancer 49(13):2784–2790CrossRefPubMedGoogle Scholar
  20. 20.
    van den Broek CB, van Gijn W, Bastiaannet E et al (2014) Differences in pre-operative treatment for rectal cancer between Norway, Sweden, Denmark, Belgium and the Netherlands. Eur J Surg Oncol 40(12):1789–1796CrossRefPubMedGoogle Scholar
  21. 21.
    International watch and wait database. Accessed July 2015

Copyright information

© Springer-Verlag Berlin Heidelberg 2018

Authors and Affiliations

  • Anne J. Breugom
    • 1
  • Cornelis J. H. van de Velde
    • 1
  1. 1.Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands

Personalised recommendations