New accreditation program for rectal cancer 
emphasizes multidisciplinary approach

Steven D. Wexner, MD, PhD(Hon), FACS, FRCS, FRCSEd
Steven D. Wexner, MD, PhD(Hon), FACS, FRCS, FRCSEd

Over the Last two decades, hospitals in several European countries have steadily improved outcomes for rectal cancer patients by working in multidisciplinary teams. In the U.S., however, rectal cancer care varies widely, a reality that’s reflected in poorer patient outcomes in comparison with what has been reported in Europe.

The new National Accreditation Program for Rectal Cancer (NAPRC) was designed to replicate the multidisciplinary approach of the European model and improve outcomes for rectal cancer patients in the U.S.

“What began in Europe as informal collaborations among surgeons, pathologists, radiologists, and oncologists evolved into the systematic practice of formal meetings among the specialties to discuss all patients with rectal cancer,” explained Steven D. Wexner, MD, PhD(Hon), FACS, FRCS, FRCSEd. “Subsequently, it was found on a national level in many European countries that by simultaneously working as a group rather than sequentially working as myriad individual specialists, outcomes improved, recurrence rates decreased, and survival increased.”

Dr. Wexner, director of the Digestive Disease Center and chair, department of colorectal surgery, Cleveland Clinic, Weston, FL, will discuss the evolution of the NAPRC on Tuesday during the annual Herand Abcarian Lecture, The Rationale for and Reality of the New ACS Commission on Cancer National Accreditation Program for Rectal Cancer.

The drive toward a new U.S. accreditation program began in 2011 when a group of colorectal surgeons, including Dr. Wexner, partnered with pathologists and radiologists to form the Optimizing the Surgical Treatment of Rectal Cancer (OSTRiCh) Consortium. The consortium’s goal was to adapt the European multidisciplinary model to the U.S. health care system.

“Obviously, we have a very different health care system than the U.K., for example, and much different challenges, but, nonetheless, that’s what we set out to do,” Dr. Wexner said. “Over the course of the next few years, we published numerous studies in many of the surgical journals highlighting some of the problems in the U.S. and the deficiencies for our rectal cancer patients as compared to what has been going on in Europe.”

In 2014, the American College of Surgeons (ACS) Commission on Cancer (CoC), of which Dr. Wexner is a member, announced its support for an accreditation program that would establish centers of excellence focused on evidence-based processes of rectal cancer care and the multidisciplinary team approach seen in Europe. That support helped to forge a collaborative process among OSTRiCh, ACS CoC, the American Society of Colon and Rectal Surgeons, the College of American Pathologists, and the American College of Radiology. The collaborative effort eventually led to the development of a preliminary standards manual and six pilot surveys, which eventually formed the foundation for what is now the NAPRC.

“As is always the case, though, not everybody is excited about the new requirements and responsibilities that go along with it. But this is a Quality Program from the ACS, and every Quality Program the ACS has put forward has ended up significantly improving patient outcomes,” Dr. Wexner said. “It may present us with some challenges, but when you think of it from the patient’s perspective, it’s the right thing to do. It’s the only thing to do.”

The Chicago Society of Colon and Rectal Surgeons established the Abcarian Lecture in 2006 to honor Dr. Abcarian, a colon and rectal surgeon. The purpose of the lecture is to address issues of relevance to the surgical community at-large and to focus on emerging issues in surgery. The lecture is sponsored by the Advisory Council for Colon and Rectal Surgery.