Conclusions

The debate on QoL should not confuse the important topic of the correct management of rectal cancer, focusing evaluation only on patients rather than disease. First, it is very important to take care on primary end-points such as survival, disease free and tumour recurrence. Rectal cancer is a complex disease to deal with and it is clear that subspecialisation is becoming necessary. Subspecialty training in col-orectal surgery and subsequent specialist board certification has a long tradition in the USA where the American Society of Colon and Rectal Surgeons was founded in 1899.

Hospital and surgeon's caseload are the key points for a successful outcome for patients, as uncorrected surgery is the first cause of high local recurrence rate [63, 67]. Porter et al. [68] stressed the importance of specific surgical competence and high caseload, as he demonstrated a higher risk of local recurrence in patients operated on by low-caseload and non-col-orectal-trained surgeons (hazard ratio for local recurrence of 4.29). As a direct consequence, there is a controversial debate about surgical training in rectal surgery [69,70] as it is mandatory to offer the best treatment for all patients.

We do think that dedicated colorectal units represent the best way to manage this problem. In the experience of our team, a multidisciplinary approach is the golden standard. In dedicated and scheduled meetings, different specialists (surgeon, oncologist, radiologist, pathologist, WOC/ET nurses, psychologists) discuss cases and plan the patients' treatment. This approach guarantees a high level of care and increases the patients' compliance with suggested medical/surgical therapy. In fact, they feel involved in a good "curative project" and this reduces the stress of approaching the different specialists.

In these specialised colorectal units, QoL assessment can help physicians and should be inserted in patients' charts [71]. It can improve comprehension of patients' needs and expectations. Only in this way can every treatment be tailored to the patient and offer the best care for each patient.

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