Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2024; 16(4): 982-987
Published online Apr 27, 2024. doi: 10.4240/wjgs.v16.i4.982
Quality assessment of surgery for colorectal cancer: Where do we stand?
Stefan Morarasu, Cristian Livadaru, Gabriel-Mihail Dimofte
Stefan Morarasu, Cristian Livadaru, Gabriel-Mihail Dimofte, The Second Department of Surgical Oncology, Regional Institute of Oncology, Iasi 707483, Romania
Conflict-of-interest statement: The authors declare having no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Corresponding author: Gabriel-Mihail Dimofte, PhD, Professor, The Second Department of Surgical Oncology, Regional Institute of Oncology, 2-4 General Berthelot St, Iasi 707483, Romania. gdimofte@gmail.com
Received: December 17, 2023
Peer-review started: December 17, 2023
First decision: February 3, 2024
Revised: February 5, 2024
Accepted: March 21, 2024
Article in press: March 21, 2024
Published online: April 27, 2024

Quality assurance in surgery has been one of the most important topics of debate among colorectal surgeons in the past decade. It has produced new surgical standards that led in part to the impressive oncological outcomes we see in many units today. Total mesorectal excision, complete mesocolic excision (CME), and the Japanese D3 lymphadenectomy are now benchmark techniques embraced by many surgeons and widely recommended by surgical societies. However, there are still ongoing discrepancies in outcomes largely based on surgeon performance. This is one of the main reasons why many countries have shifted colorectal cancer surgery only to high volume centers. Defining markers of surgical quality is thus a perquisite to ensure that standards and oncological outcomes are met at an institutional level. With the evolution of CME surgery, various quality markers have been described, mostly based on measurements on the surgical specimen and lymph node yield, while others have proposed radiological markers (i.e. arterial stumps) measured on postoperative scans as part of the routine cancer follow-up. There is no ideal marker; however, taken together and assembled into a new score or set of criteria may become a future point of reference for reporting outcomes of colorectal cancer surgery in research studies and defining subspecialization requirements both at an individual and hospital level.

Keywords: Colorectal cancer, Colon surgery, Arterial stump, Complete mesocolic excision, Surgical quality

Core Tip: Quality assurance in colorectal cancer surgery has had a major impact on survival, and it is likely the most important factor contributing to the unprecedented decrease in local recurrences. Due to total mesorectal excision and complete mesocolic excision, we have a set of quality markers that can be used as tools to predict outcomes and guide surgical and oncological management in at-risk patients. While there is strong evidence supporting the value of quality markers, we must promote their use at national and institutional levels as a perquisite of good practice, thus offering our patients the best chances of cure.