During the last 20 years, the outcomes of rectal cancer have repeatedly been shown to be tremendously variable and highly contingent upon specialization, training, and volume.
These variations have been confirmed in the United States. One study showed that patients in the state of California were as likely to be operated upon at a low-volume as a medium-volume or high-volume hospital. There were highly significant differences in favor of high-volume hospitals relative to mortality and rates of sphincter preservation.
In a study, Ricciardi and colleagues assessed 20,000 proctectomies undertaken between 2002 and 2004 and analyzed county data in 21 states. Fifty percent of patients underwent construction of permanent stoma and only 20 percent of the 21 counties offered colostomy rates less than 40 percent.
These same problems had existed in Europe, but through numerous national initiatives, outcomes have been improved. Specific measureable improvements have been noted in the rates of complete total mesorectal excision, the rates of permanent stoma construction, the incidence of local recurrence, and overall survival.
Based on the significant variability in the United States and the fact that a number of European countries were able to, on a national level, improve the quality of rectal cancer care, the National Accreditation Program for Rectal Cancer (NAPRC) aims to standardize and improve care using a multidisciplinary approach.