The National Accreditation Program for Rectal Cancer (NAPRC) was formed to address the differences between patient outcomes in the United States as compared to Europe. [1] [2] According to the American College of Surgeons, outcomes for rectal cancer patients in Europe have for years been significantly better than for those in the U.S. Characterized by the use of multidisciplinary teams to make treatment decisions, the NAPRC standards aim to decrease the average circumferential resection margins, decrease the overall colostomy rate, and increase quality of life as reported by recovering patients. [3] [4] [5] [6]
Two statistics illustrate the difference in treatment. A decade ago, the colostomy rate in Europe ranged from 25 percent to 35 percent, while today’s colostomy rate in the U.S. is about 50 percent, meaning that many more patients in the U.S. have colostomies as compared to Europeans. Rectal cancer cases in the U.S. have an average circumferential resection margins (CRMs) rate of 17 percent, significantly higher than the 3 percent to 11 percent range for European countries. [7]
Collaboration between numerous professional organizations served as the driving force behind the creation of the NAPRC and its standards. [8] To create the new standards and address the disparities between treatment in Europe and the U.S., the OSTRiCh (Optimizing Surgical Treatment of Rectal Cancer) Consortium was created by the American College of Surgeons and its Commission on Cancer (CoC) working with the American Society of Colon and Rectal Surgeons (ASCRS), the College of American Pathologists, the American College of Radiology, the Society of Gastrointestinal and Endoscopic Surgeons (SAGES), the Society for the Surgery of the Alimentary Tract and Society of Surgical Oncology. Lead members of the steering committee include Steven D. Wexner, MD, FACS, past president of the ASCRS, and Frederick L. Greene, MD, FACS, past chair of the CoC. The NAPRC is the fourth accreditation program approved by the CoC.
Prior to the CoC's creation of the NAPRC, a study was conducted on the current state of treatment in the US. The study was published in the Journal of the American College of Surgeons. The results showed that the full set of proposed quality standards were only met in 28.1% of patients, who were all diagnosed between 2011 and 2014 with non-metastatic rectal cancer. [9] The completion of these measures varied based on location of the facility, type of facility, insurance, race, stage of disease, and operative volume. [10] </ref> The study's authors plan to review the data once more in two or three years, [11] According to the CoC, an inclusive approach was taken with the goal of providing the maximum number of patients with the option to go to an accredited facility.
In June 2017 the ACS issued a press release stating that the NAPRC is accepting applications. [12] Accreditation requires previous CoC accreditation, an on-site visit, and records showing that NAPRC standards have been in place for no less than twelve months.
The chair of the NAPRC is Steven D. Wexner, MD. The vice chair is James W. Fleshman, Jr., MD.
One of the main requirements of maintaining NAPRC accreditation is having multidisciplinary teams, i.e., the establishment and use of teams that include not only the surgeon, but also representatives from pathology, radiology, imaging, and medical oncology. [13] This is similar to the existing National Accreditation Program for Breast Cancer, which various facilities already have in place. [14] This team model is based on European standards of care and medical practice, [15] and it entails collaboration by team members on decisions regarding therapy and all aspects of surgical treatment. When these multidisciplinary teams were put into place in Europe, they saw improved outcomes for patients as well as a decrease in recurrence rates and an increase in overall survival rates. [16]
Another main requirement is the use of synoptic rather than narrative reporting. According to the American College of Surgeons, synoptic reports have been shown to collect 99 percent of critical patient data, while narrative reports typically capture less than 50 percent, according to studies on the subject. When patients are provided with specific checklists and questions, they report significantly more details which may be pertinent to future care.
Overall there are 22 different standards in the accreditation program, which each fall into one of three categories: program management, clinical services, or quality improvement. [17] [18] These were tested at six hospitals prior to being finalized. [19]
Standard Number | Standard |
---|---|
Chapter 1 | Program Management |
1.1 | Commission on Cancer Accreditation |
1.2 | Rectal Cancer Multidisciplinary Care |
1.3 | Rectal Cancer Multidisciplinary Team Attendance |
1.4 | Rectal Cancer Multidisciplinary Team Meetings |
1.5 | Rectal Cancer Program Director |
1.6 | Rectal Cancer Program Coordinator |
1.7 | Rectal Cancer Program Education |
Chapter 2 | Clinical Services |
2.1 | Review of Diagnostic Pathology |
2.2 | Staging before Definitive Treatment |
2.3 | Standardized Staging Reporting for Magnetic Resonance Imaging Results |
2.4 | Carcinoembryonic Antigen Level |
2.5 | Rectal Cancer Multidisciplinary Team Treatment Planning Discussion |
2.6 | Treatment Evaluation and Recommendation Summary |
2.7 | Definitive Treatment Timing |
2.8 | Surgical Resection and Standardized Operative Reporting |
2.9 | Pathology Reports after Surgical Resection |
2.10 | Photographs of Surgical Specimens |
2.11 | Multidisciplinary Team Treatment Outcome Discussion |
2.12 | Treatment Outcome Discussion Summary |
2.13 | Adjuvant Therapy after Surgical Resection |
Chapter 3 | Quality Improvement |
3.1 | Rapid Quality Reporting System |
3.2 | Accountability and Quality Improvement Measures |
The NAPRC began accepting applications in July 2017. [20]
As of June 2018, the following institutions have completed the full survey process to receive accreditation:
John Muir Health Rectal Program in Walnut Creek and Concord, CA
Cleveland Clinic Weston Rectal Cancer Program in Weston, FL [21]
General surgery is a surgical specialty that focuses on alimentary canal and abdominal contents including the esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, appendix and bile ducts, and often the thyroid gland. They also deal with diseases involving the skin, breast, soft tissue, trauma, peripheral artery disease and hernias and perform endoscopic as such as gastroscopy, colonoscopy and laparoscopic procedures.
Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer from the colon or rectum. Signs and symptoms may include blood in the stool, a change in bowel movements, weight loss, and fatigue. Most colorectal cancers are due to old age and lifestyle factors, with only a small number of cases due to underlying genetic disorders. Risk factors include diet, obesity, smoking, and lack of physical activity. Dietary factors that increase the risk include red meat, processed meat, and alcohol. Another risk factor is inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis. Some of the inherited genetic disorders that can cause colorectal cancer include familial adenomatous polyposis and hereditary non-polyposis colon cancer; however, these represent less than 5% of cases. It typically starts as a benign tumor, often in the form of a polyp, which over time becomes cancerous.
Diverticulitis, specifically colonic diverticulitis, is a gastrointestinal disease characterized by inflammation of abnormal pouches—diverticula—which can develop in the wall of the large intestine. Symptoms typically include lower abdominal pain of sudden onset, but the onset may also occur over a few days. There may also be nausea; and diarrhea or constipation. Fever or blood in the stool suggests a complication. Repeated attacks may occur.
Colorectal surgery is a field in medicine dealing with disorders of the rectum, anus, and colon. The field is also known as proctology, but this term is now used infrequently within medicine and is most often employed to identify practices relating to the anus and rectum in particular. The word proctology is derived from the Greek words πρωκτός proktos, meaning "anus" or "hindparts", and -λογία -logia, meaning "science" or "study".
A colostomy is an opening (stoma) in the large intestine (colon), or the surgical procedure that creates one. The opening is formed by drawing the healthy end of the colon through an incision in the anterior abdominal wall and suturing it into place. This opening, often in conjunction with an attached ostomy system, provides an alternative channel for feces to leave the body. Thus if the natural anus is unavailable for that function, an artificial anus takes over. It may be reversible or irreversible, depending on the circumstances.
An abdomino perineal resection, formally known as abdominoperineal resection of the rectum and abdominoperineal excision of the rectum is a surgery for rectal cancer or anal cancer. It is frequently abbreviated as AP resection, APR and APER.
Ileostomy is a stoma constructed by bringing the end or loop of small intestine out onto the surface of the skin, or the surgical procedure which creates this opening. Intestinal waste passes out of the ileostomy and is collected in an external ostomy system which is placed next to the opening. Ileostomies are usually sited above the groin on the right hand side of the abdomen.
Colectomy is bowel resection of the large bowel (colon). It consists of the surgical removal of any extent of the colon, usually segmental resection. In extreme cases where the entire large intestine is removed, it is called total colectomy, and proctocolectomy denotes that the rectum is included.
The American Joint Committee on Cancer (AJCC) is an organization best known for defining and popularizing cancer staging standards, officially the AJCC staging system.
Vaginectomy is a surgery to remove all or part of the vagina. It is one form of treatment for individuals with vaginal cancer or rectal cancer that is used to remove tissue with cancerous cells. It can also be used in gender affirmation surgery. Some people born with a vagina who identify as trans men or as nonbinary may choose vaginectomy in conjunction with other surgeries to make the clitoris more penis-like (metoidioplasty), construct of a full-size penis (phalloplasty), or create a relatively smooth, featureless genital area.
A proctosigmoidectomy, Hartmann's operation or Hartmann's procedure is the surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy. It was used to treat colon cancer or inflammation. Currently, its use is limited to emergency surgery when immediate anastomosis is not possible, or more rarely it is used palliatively in patients with colorectal tumours.
Total mesorectal excision (TME) is a standard surgical technique for treatment of rectal cancer, first described in 1982 by Professor Bill Heald at the UK's Basingstoke District Hospital. It is a precise dissection of the mesorectal envelope comprising rectum containing the tumour together with all the surrounding fatty tissue and the sheet of tissue that contains lymph nodes and blood vessels. Dissection is along the avascular alveolar plane between the presacral and mesorectal fascia, described as holy plane. Dissection along this plane facilitates a straightforward dissection and preserves the sacral vessels and hypogastric nerves and is a sphincter-sparing resection and decreases permanent stoma rates. It is possible to rejoin the two ends of the colon; however, most patients require a temporary ileostomy pouch to bypass the colon, allowing it to heal with less risk of infection, perforation or leakage.
A lower anterior resection, formally known as anterior resection of the rectum and colon and anterior excision of the rectum or simply anterior resection, is a common surgery for rectal cancer and occasionally is performed to remove a diseased or ruptured portion of the intestine in cases of diverticulitis. It is commonly abbreviated as LAR.
William Ernest Miles was an English surgeon known for the Miles' operation: an abdomino-perineal excision for rectal cancer.
The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) is a 501c6 non-profit professional organization providing education on gastrointestinal minimally invasive surgery. It describes itself thus: The mission of the Society of American Gastrointestinal and Endoscopic Surgeons is to innovate, educate and collaborate to improve patient care.
A. K. M. Fazlul Haque is a Bangladeshi surgeon. He was the founder of the Department of Colorectal Surgery in Bangabandhu Sheikh Mujib Medical University (BSMMU) in Dhaka.
Northern Westchester Hospital (NWH), now known as Northwell Health, is a not-for-profit, 245-bed, all-private-room facility in Mount Kisco, New York. Founded in 1916, it serves residents of Northern Westchester, Putnam County and southern Dutchess County, as well as parts of Fairfield County, Connecticut.
The American Society of Colon and Rectal Surgeons (ASCRS), formerly the American Proctologic Society, is a professional society for surgeons specializing in colorectal surgery. It is one of the oldest surgical societies, having been established in 1899.
Steven D. Wexner is an American surgeon and physician. He is Director of the Ellen Leifer Shulman and Steven Shulman Digestive Disease Center at Cleveland Clinic Florida. Wexner has received numerous regional, national, and international research awards. Through his multiple academic appointments, Wexner personally trains 15-20 surgeons each year, and he educates thousands more around the world through conferences and lectures. He maintains an exceptionally busy clinical practice and innovative cutting-edge research. He is a resource for his colleagues from around the world for referral of patients with challenging or complex problems. In 2020, he was elected Vice-Chair of the Board of Regents of the American College of Surgeons for a one year term. Since 1990. he has served as Symposium Director of the Cleveland Clinic Annual International Colorectal Disease Symposium. The Symposium was held in Fort Lauderdale or Boca Raton every year from 1990 to 2019. Since 2020, the Symposium has expanded to include host locations outside of the USA with interruptions during the pandemic years of 2021-2022.
Conor P. Delaney MD, MCh, PhD, FRCSI, FACS, FASCRS, FRCSI (Hon.) is an Irish-American colorectal surgeon, CEO and President of the Cleveland Clinic Florida, the Robert and Suzanne Tomsich Distinguished Chair in Healthcare Innovation, and Professor of Surgery at the Cleveland Clinic Lerner College of Medicine. He is also the current President of the American Society of Colon and Rectal Surgeons (ASCRS). He was previously Chairman of the Digestive Disease & Surgery Institute at the Cleveland Clinic. He is both a Fellow and Honorary Fellow of the Royal College of Surgeons in Ireland and a Fellow of both the American College of Surgeons and American Society of Colon and Rectal Surgeons.
{{cite news}}
: |last=
has generic name (help)