• Justin T Brady, Zhaomin Xu, Kelly B Scarberry, Amin Saad, Fergal J Fleming, Feza H Remzi, Steven D Wexner, David P Winchester, Monson John R T JRT Center for Colon and Rectal Surgery, Florida Hospital Cancer Institute, Orlando, FL., Lawrence Lee, David W Dietz, and Consortium for Optimizing the Treatment of Rectal Cancer (OSTRiCh).
• Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.
• J. Am. Coll. Surg. 2018 May 1; 226 (5): 881-890.

BackgroundIn an effort to improve the quality of rectal cancer care in the US, the American College of Surgeons Commission on Cancer has developed the National Accreditation Program for Rectal Cancer (NAPRC). We aimed to describe the current status of rectal cancer care before implementation of the NAPRC.Study DesignThe 2011-2014 National Cancer Database was queried for non-metastatic rectal cancer patients who underwent proctectomy. The NAPRC process measures evaluated included clinical staging completion, treatment starting fewer than 60 days from diagnosis, CEA level drawn before treatment, tumor regression grading, and margin assessment. The NAPRC performance measures included negative proximal, distal, and circumferential margins, and ≥12 lymph nodes harvested during resection.ResultsThere were 39,068 patients identified (mean age 62 years, 61.6% male sex). In >85% of patients, clinical staging was completed, treatment was started within 60 days, and all tumor margins were assessed. Pretreatment CEA level (64.6% complete) was the process measure most often omitted. However, completion of all included process measures occurred in only 28.1% of patients. All pathologic margins were negative in 79.8% of patients and 73.2% of specimens reported ≥12 lymph nodes. Overall, 56.3% of patients achieved all performance measures. Patients treated at high-volume centers (>30 cases/year) had higher odds of meeting all performance measures (odds ratio 1.42; p < 0.001).ConclusionsOverall, very few patients achieved all of the proposed quality measures for rectal cancer care. It will be important to re-evaluate these data after the implementation of the NAPRC.Copyright © 2018. Published by Elsevier Inc.

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