title: The English national low rectal cancer development programme: key messages and future perspectives.
abstract: OBJECTIVE
  Adenocarcinoma of the lower rectum is clinically challenging because of the need to choose between a wide excision to achieve oncological clearance, on the one hand, and sphincter conservation to maintain anal function, on the other. The English National Low Rectal Cancer Development Programme (LOREC) was developed under the auspices of the Association of Coloproctology of Great Britain and Ireland and the English National Cancer Action Team to improve the outcome of low rectal cancer in England.
  
  
  METHODS
  LOREC was initiated focusing on preoperative imaging, selective neoadjuvant therapy, optimal surgical treatment and detailed pathological assessment of the excised specimen. Its key elements were 1-day multidisciplinary team (MDT) workshops, cadaveric surgical training, surgical mentoring, pathological audit and radiological workshops.
  
  
  RESULTS
  Overall, 147 (89.6%) of 164 MDTs from 151 National Health Service (NHS) Trusts (some with two MDTs) in England participated in 15 workshops in Basingstoke or Leeds. In addition, 112 surgeons attended a 1-day cadaveric training programme in Bristol, Newcastle or Nottingham, with the main focus on extralevator abdominoperineal excision and pelvic reconstruction, with input from anatomists and from colorectal and plastic surgeons.
  
  
  CONCLUSIONS
  Optimal staging, selective preoperative chemoradiotherapy and precise surgery were considered as crucial to improve the outcome for patients with low rectal cancer.
authors.affiliation: Colorectal Surgery, Hampshire Hospitals Foundation Trust, Basingstoke, UK.
authors.forename: B J
authors.initials: BJ
authors.lastname: Moran
authors.forename: T
authors.initials: T
authors.lastname: Holm
authors.forename: G
authors.initials: G
authors.lastname: Brannagan
authors.forename: H
authors.initials: H
authors.lastname: Chave
authors.forename: P
authors.initials: P
authors.lastname: Quirke
authors.forename: N
authors.initials: N
authors.lastname: West
authors.forename: G
authors.initials: G
authors.lastname: Brown
authors.forename: R
authors.initials: R
authors.lastname: Glynne-Jones
authors.forename: D
authors.initials: D
authors.lastname: Sebag-Montefiore
authors.forename: C
authors.initials: C
authors.lastname: Cunningham
authors.forename: A Z
authors.initials: AZ
authors.lastname: Janjua
authors.forename: N J
authors.initials: NJ
authors.lastname: Battersby
authors.forename: S
authors.initials: S
authors.lastname: Crane
authors.forename: A
authors.initials: A
authors.lastname: McMeeking
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery* / Q000628:therapy; D001003:Anal Canal; D059248:Chemoradiotherapy / Q000379:methods; D003107:Colorectal Surgery / Q000193:education; D004502:Education, Medical, Continuing / Q000379:methods; D004739:England; D005242:Fecal Incontinence / Q000517:prevention & control; D006801:Humans; D020360:Neoadjuvant Therapy / Q000379:methods; D059351:Organ Sparing Treatments / Q000379:methods*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery* / Q000628:therapy
keywords: Low rectal cancer; National MDT Programme