title: Clinical competence in the surgery of rectal cancer: the Italian Consensus Conference.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.forename: Micaela
authors.initials: M
authors.lastname: Piccoli
authors.affiliation: Department of General and Emergency Surgery, NOCSAE, Modena, Italy.
authors.forename: Piccoli
authors.initials: P
authors.lastname: Micaela
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Agresta
authors.forename: Agresta
authors.initials: A
authors.lastname: Ferdinando
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Trapani
authors.forename: Trapani
authors.initials: T
authors.lastname: Vincenzo
authors.forename: Casimiro
authors.initials: C
authors.lastname: Nigro
authors.forename: Nigro
authors.initials: N
authors.lastname: Casimiro
authors.forename: Vito
authors.initials: V
authors.lastname: Pende
authors.forename: Pende
authors.initials: P
authors.lastname: Vito
authors.forename: Fabio Cesare
authors.initials: FC
authors.lastname: Campanile
authors.forename: Campanile Fabio
authors.initials: CF
authors.lastname: Cesare
authors.forename: Nereo
authors.initials: N
authors.lastname: Vettoretto
authors.forename: Vettoretto
authors.initials: V
authors.lastname: Nereo
authors.forename: Enrico
authors.initials: E
authors.lastname: Belluco
authors.forename: Belluco
authors.initials: B
authors.lastname: Enrico
authors.forename: Paolo Pietro
authors.initials: PP
authors.lastname: Bianchi
authors.forename: Bianchi Pietro
authors.initials: BP
authors.lastname: Paolo
authors.forename: Davide
authors.initials: D
authors.lastname: Cavaliere
authors.forename: Cavaliere
authors.initials: C
authors.lastname: Davide
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ferulano
authors.forename: Ferulano
authors.initials: F
authors.lastname: Giuseppe
authors.forename: Filippo
authors.initials: F
authors.lastname: La Torre
authors.forename: La Torre
authors.initials: LT
authors.lastname: Filippo
authors.forename: Marco Maria
authors.initials: MM
authors.lastname: Lirici
authors.forename: Lirici Marco
authors.initials: LM
authors.lastname: Maria
authors.forename: Roberto
authors.initials: R
authors.lastname: Rea
authors.forename: Rea
authors.initials: R
authors.lastname: Roberto
authors.forename: Gianni
authors.initials: G
authors.lastname: Ricco
authors.forename: Ricco
authors.initials: R
authors.lastname: Gianni
authors.forename: Elena
authors.initials: E
authors.lastname: Orsenigo
authors.forename: Orsenigo
authors.initials: O
authors.lastname: Elena
authors.forename: Simona
authors.initials: S
authors.lastname: Barlera
authors.forename: Barlera
authors.initials: B
authors.lastname: Simona
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lettieri
authors.forename: Lettieri
authors.initials: L
authors.lastname: Emanuele
authors.forename: Giovanni Maria
authors.initials: GM
authors.lastname: Romano
authors.forename: Romano Giovanni
authors.initials: RG
authors.lastname: Maria
mesh_terms: D001003:Anal Canal / Q000601:surgery; D002983:Clinical Competence; D061847:Hospitals, High-Volume / Q000592:standards*; D006801:Humans; D010535:Laparoscopy; D008866:Microsurgery; D009364:Neoplasm Recurrence, Local; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome