Training and quality assurance for rectal cancer: 20 years of data is enough.

Rectal cancer is a common disease with a high rate of mortality. During the past 20 years, substantial improvements have been made in the surgical, pathological, radiological, and oncological approaches used to treat this disease, but there is good evidence for continuing suboptimum performances among the teams that treat patients with colorectal cancers. Studies involving more than 4000 patients show that large reductions in local recurrences and a 20% increase in survival can be achieved with high-quality surgical and pathological training in total mesorectal excision. New developments in radiology and oncology may further increase this benefit.