Clinical competence in the surgery of rectal cancer: The Italian Consensus Conference

Piccoli Micaela, Agresta Ferdinando, Trapani Vincenzo, Nigro Casimiro, Pende Vito, Campanile Fabio Cesare, Vettoretto Nereo, Belluco Enrico, Bianchi Pietro Paolo, Cavaliere Davide, Ferulano Giuseppe, La Torre Filippo, Lirici Marco Maria, Rea Roberto, Ricco Gianni, Orsenigo Elena, Barlera Simona, Lettieri Emanuele, Romano Giovanni Maria

Research output: Contribution to journalArticlepeer-review


Background and aim: The literature continues to emphasize the advantages of treating patients in "high volume" units by "expert" surgeons, but there is no agreed definition of what is meant by either term. In September 2012, a Consensus Conference on Clinical Competence was organized in Rome as part of the meeting of the National Congress of Italian Surgery (I Congresso Nazionale della Chirurgia Italiana: Unità e valore della chirurgia italiana). The aims were to provide a definition of "expert surgeon" and "high-volume facility" in rectal cancer surgery and to assess their influence on patient outcome. Method: An Organizing Committee (OC), a Scientific Committee (SC), a Group of Experts (E) and a Panel/Jury (P) were set up for the conduct of the Consensus Conference. Review of the literature focused on three main questions including training, "measuring" of quality and to what extent hospital and surgeon volume affects sphincter-preserving procedures, local recurrence, 30-day morbidity and mortality, survival, function, choice of laparoscopic approach and the choice of transanal endoscopic microsurgery (TEM). Results and conclusion: The difficulties encountered in defining competence in rectal surgery arise from the great heterogeneity of the parameters described in the literature to quantify it. Acquisition of data is difficult as many articles were published many years ago. Even with a focus on surgeon and hospital volume, it is difficult to define their role owing to the variability and the quality of the relevant studies.

Original languageEnglish
Pages (from-to)863-875
Number of pages13
JournalInternational Journal of Colorectal Disease
Issue number7
Publication statusPublished - 2014


  • Clinical competence
  • Guidelines
  • Quality of life
  • Rectal cancer
  • Surgery

ASJC Scopus subject areas

  • Gastroenterology
  • Medicine(all)


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