European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
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Clinical trials and registers data for quality assurance have been mandatory to achieve the good results and the enormous evolution which has been involved in rectal cancer surgery during the past 20 years. The whole business came into focus when local recurrences were considered as a matter of tumour biology and radiotherapy was introduced in many countries as a standard treatment in rectal cancer patients to reduce the local recurrence rate and to improve survival. ⋯ In short, a summary of those meta-analyses has shown that radiotherapy reduces the local recurrence rate with 50%. Moreover, it has been revealed that pre-operative radiotherapy is better than post-operative radiotherapy in attempt to reduce the local recurrence rate and finally that there is a survival benefit with this reduction of the local recurrence rate.
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Surgical treatment of cancer of the esophagus and gastroesophageal junction (GEJ) remains a complex and challenging task. Quality of care may be improved by concentrating these patients in high volume centres in order to decrease post-operative mortality. However, it appears that hospital mortality is a poor tool to measure the quality. ⋯ Such a standardisation and the resulting improved quality most likely will result in a significant improvement of outcome of esophagectomy for cancer of the esophagus and GEJ. These improvements in outcome should become the gold standard to which all other therapeutic regimens should be compared. Poor surgical quality and related poor results should not be a justification for multimodality regimen.
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Quality assurance in colon cancer demands a multidisciplinary effort involving general practitioners, surgeons, radiologists, gastroenterologists, medical oncologists, and pathologists, among others. Maximal improvements in survival will result when colon cancer screening, diagnosis, staging, treatment and surveillance are optimized. We seek to identify those issues most relevant to the quality of care we provide our colon cancer patients.