title: Multidisciplinary management of rectal cancer: the OSTRICH.
abstract: BACKGROUND
  Disparity exists in outcomes for rectal cancer patients in the US. Similar problems in several European countries have been addressed by the creation of national networks of rectal cancer centers of excellence (CoEs) that follow evidence-based care pathways and specified protocols of care and process and are certified by regular external validation.
  
  
  OBJECTIVE
  This paper reviews the current status of rectal cancer care in the U.S. and examines the evidence for multidisciplinary rectal cancer management. A U.S. rectal cancer CoE system based on the existing U.K. model is proposed.
  
  
  METHODS
  A literature search was performed for publications related to US rectal cancer outcomes, multidisciplinary management of rectal cancer, and European rectal cancer programs.
  
  
  RESULTS
  U.S. rectal cancer outcomes are highly variable. The majority of US rectal cancer patients are treated by generalists in low-volume hospitals. Current evidence supports five main principles of rectal cancer care that have been incorporated into European rectal cancer CoE programs. These programs have dramatically improved rectal cancer outcomes in Scandanavian countries and the U.K.
  
  
  CONCLUSIONS
  A similar CoE program should be established in the U.S. to improve the outcomes of rectal cancer patients.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA, dietzd2@ccf.org.
authors.forename: David W
authors.initials: DW
authors.lastname: Dietz
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D010348:Patient Care Team / Q000592:standards; D012004:Rectal Neoplasms / Q000601:surgery / Q000628:therapy*; D012537:Scandinavian and Nordic Countries; D006113:United Kingdom; D014481:United States