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This document is a response to a previous paper on the impact of hospital and surgeon volumes on outcomes in rectal cancer surgery. The authors agree that quality improvement measures are important in the treatment of rectal cancer, but express concern about the message offered by the previous paper regarding case volumes. They argue that specialization, rather than centralization, is crucial in the treatment of rectal cancer and support the minimum surgical volume caseload outlined by the National Institute of Health and Care Excellence (NICE) guidance. The authors also emphasize the complexity and diversity of surgical options for rectal cancer and the need for a significant skill set to achieve optimal outcomes. They cite evidence that higher-volume surgeons have improved mortality rates and advocate for higher individual surgeon case volumes to encourage specialization. The authors suggest that patient and trainee perspectives should be considered when determining appropriate strategies for the treatment of rectal cancer. They acknowledge the limitations of the data presented in the previous paper and emphasize the importance of interpreting the data in the context of patient care. No funding or conflicts of interest are reported. Ethical approval was not required for this response. [Extracted from the article]

Objective: To examine the impact of The National Training Program for Lapco on the rate of laparoscopic surgery and clinical outcomes of cases performed by Lapco surgeons after completion of training. Summary of Background Data: Lapco provided competency-based supervised clinical training for specialist colorectal surgeons in England. Methods: We compared the rate of laparoscopic surgery, mortality, and morbidity for colorectal cancer resections by Lapco delegates and non-Lapco surgeons in 3-year periods preceding and following Lapco using difference in differences analysis. The changes in the rate of post-Lapco laparoscopic surgery with the Lapco sign-off competency assessment and in-training global assessment scores were examined using risk-adjusted cumulative sum to determine their predictive clinical validity with predefined competent scores of 3 and 5 respectively. Results: One hundred eight Lapco delegates performed 4586 elective colo-rectal resections pre-Lapco and 5115 post-Lapco while non-Lapco surgeons performed 72,930 matched cases. Lapco delegates had a 37.8% increase in laparoscopic surgery which was greater than non-Lapco surgeons by 20.9% [95% confidence interval (CI), 18.5–23.3, P < 0.001) with a relative decrease in 30-day mortality by -1.6% (95% CI, -3.4 to -0.2, P = 0.039) and 90-day mortality by -2.3% (95% CI, -4.3 to -0.4, P = 0.018). The change point of risk-adjusted cumulative sum was 3.12 for competency assessment tool and 4.74 for global assessment score whereas laparoscopic rate increased from 44% to 66% and 40% to 56%, respectively. Conclusions: Lapco increased the rate of laparoscopic colorectal cancer surgery and reduced mortality and morbidity in England. In-training competency assessment tools predicted clinical performance after training. [ABSTRACT FROM AUTHOR]

2022; 24 (1): 6 - 7. 3 Wood N, Dobbs S, Tierney G, Maxwell-Armstrong C, Sundar S. How do we deliver safe bowel resection in ovarian cancer cytoreductive surgery? Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC): a joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG). I was grateful to Shahab Siddiqui for doing an extra year on the Executive, and he along with colleagues in External Affairs have ensured that the website remains up to date and that the ACPGBI newsletter remains topical. [Extracted from the article]

This is a summary of the history of the Association of Coloproctology of Great Britain and Ireland from its inception in the late 1980s to the present day. [ABSTRACT FROM AUTHOR]