International Benchmarking Study of Pelvic Exenteration for Rectal Cancer (BeSt-PE)

Pelvic exenteration (PE) is now widely considered the standard of care for appropriately selected patients presenting with locally advanced or recurrent rectal cancer . Due to the encouraging oncological and quality of life outcomes reported for these patients in recent decades, there has been increasing interest in PE globally and a corresponding increase in the number of colorectal surgeons and specialist centres offering exenterative surgery. Such radical surgery is, however, associated with substantial morbidity , functional consequences and at least a temporary reduction in quality of life , and is therefore only justified by the reasonable chance of cure, for which R0 resection margins have been consistently identified as the most important predictor . Several recent comparative studies have demonstrated substantial variability in outcomes of PE between centres, particularly with respect to rates of R0 resection . Benchmarking is a well established concept in economics, where it is a concept commonly applied to quality improvement. More recently benchmarking has been used to assess surgical performance in complex abdominal surgery . In this context, benchmarking involves identifying a procedure of interest and comparing the outcomes of that procedure at a particular centre to the best possible outcomes (the benchmark) . The difference between a centre’s outcome and the benchmark is a measure of the potential for improvement. This study aims to identify the international benchmark thresholds for pelvic exenteration for locally advanced primary and recurrent rectal cancer, i.e. the best possible outcomes achievable at experienced, specialists centres. This will allow centres (particularly those early in their learning curve) to continuously compare their performance to defined international benchmarks and identify areas for potential improvement.