Better surgery and better selection for adjuvants--still the key to improving outcomes in rectal cancer

In reviewing the current issues in rectal cancer management the word specialist recurs again and again. The modern hospital requires consultants with special interest in each of the key stages of decision making: Clinical assessment--usually the surgeon MRI. Fine slice individually orientated phased array coil studies with a specially trained radiologist. CT--now routine for metastases Neo-adjuvant therapy. Special interest in the disease in both clinical and medical oncology is essential.

The challenges of the distal pelvis make it increasingly unacceptable for surgeons without a "special interest" to operate on mid and low cancer. Histopathology: The lessons of Professor Quirke have brought the specialised histopathologist out of his laboratory into the cruel role of "surgical auditor"--providing circumferential margin examination plus naked eye, TME quality assessment. This gives us two invaluable measurable short-term goals improving the quality for surgical practice. When a hospital can provide special interest doctors in all these fields and when they co-operate in a constructive manner the modern colorectal MDT can lead the way for the whole field of cancer management. It remains a probability that the use of high definition improved quality video based teaching of surgical technique is the single most effective weapon that we have in our battle against this most challenging of malignanvies.