# Rectal Cancer — GCMD Library living collection

Everything in the library about rectal cancer — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 55 cited statements

## Episodes
### Evidence & Research
- [Best of the Best Gen Surg - How Far is Too Far Cost-effectiveness Analysis of Regionalized Rectal Cancer Surgery - Dr. Leeds](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858) — video · 12:26 · [machine version](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858.md)

### In-Depth Reviews
- [Colon Cancer with Conor Delaney](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443) — podcast · 26:50 · [machine version](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443.md)

### Emerging & Future Directions
- [Surgical telementoring-emerging technologies: Comparative Technology in...](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966) — video · 30:18 · [machine version](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966.md)

## Chapters
- [0:00](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=0) Introduction to Project 6 and Surgical Telementoring Fundamentals (Ep 1)
- [4:00](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=240) Telestration and Data Security Requirements (Ep 1)
- [8:00](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=480) Skype for Business Platform Review (Ep 1)
- [12:00](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=720) Remote Desktop Software Platforms (Ep 1)
- [16:00](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=960) Cleveland-Norway Telementoring Experience and On-Site Collaboration Platform (Ep 1)
- [19:00](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=1140) Upsurge, OR Network, STAR Platform, and Low-Cost Indian System (Ep 1)
- [20:49](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=1249) Discussion: Practical Challenges and Future Directions (Ep 1)
- [26:45](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=1605) Defining Surgical Telementoring vs Telemedicine (Ep 1)
- [0:00](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=0) Introduction and Serrated Adenomas in Colonoscopy (Ep 2)
- [3:03](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=183) Rectal Cancer Location and Surgical Margins (Ep 2)
- [7:00](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=420) Rectal Cancer Staging with MRI and Circumferential Resection Margin (Ep 2)
- [11:33](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=693) Neoadjuvant Therapy Indications and Transanal Resection (Ep 2)
- [15:58](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=958) ESD vs Full-Thickness Excision for Rectal Lesions (Ep 2)
- [17:18](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1038) Sigmoid and Colon Cancer Surgical Principles (Ep 2)
- [21:22](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1282) Right Hemicolectomy Technique and Anastomosis (Ep 2)
- [24:12](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1452) Genetic Assessment and Hereditary Cancer Syndromes (Ep 2)
- [0:00](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=0) Introduction and poll results announcement (Ep 3)
- [1:04](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=64) Cost-effectiveness analysis of regionalized rectal cancer surgery (Ep 3)
- [5:29](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=329) Discussion of model assumptions and mechanisms of benefit (Ep 3)
- [8:52](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=532) Impact of technology costs and surgeon-level outcomes (Ep 3)
- [10:41](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=641) De-regionalization and technology-enabled decentralized care (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Colonoscopy is still the best test for colon cancer detection, finding the vast majority of cancers and polyps, though not perfect. — Conor Delaney (clinical) [Ep 2 · 1:16](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=76)
- Serrated adenomas (previously misclassified as hyperplastic polyps, particularly large ones in the right colon) have genetic predisposition, tie into family cancer syndromes, and carry very high cancer risk. — Conor Delaney (clinical) [Ep 2 · 2:05](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=125)
- Finding serrated adenomas requires family assessment for hereditary cancer syndromes and may necessitate changes in colonoscopy frequency and family member screening. — Conor Delaney (guideline) [Ep 2 · 2:42](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=162)
- Serrated polyps can be flat and difficult to visualize; retroflexion in the cecum is increasingly used because they are often on the inferior or superior side of folds. — Conor Delaney (clinical) [Ep 2 · 3:27](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=207)
- For rectal cancer, distal margin requirements are 5 cm if achievable, 2 cm if necessary, and 1 cm for very low tumors as long as they are not poorly differentiated. — Conor Delaney (clinical) [Ep 2 · 6:13](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=373)
- The measurement '6 centimeters from the anal verge' varies significantly by patient body habitus and can represent different anatomical locations (anorectal ring vs. near dentate line). — Conor Delaney (clinical) [Ep 2 · 7:25](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=445)
- Distant staging for rectal cancer is best performed with CT abdomen (for liver metastases) and CT chest (replacing chest X-ray per current guidelines). — Conor Delaney (guideline) [Ep 2 · 9:31](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=571)
- MRI has become the standard for local staging of rectal cancer, with high-resolution, high-Tesla magnets using standardized protocols developed by Bill Heald and Gina Brown at the Royal Marsden. — Conor Delaney (clinical) [Ep 2 · 9:50](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=590)
- MRI is 90 to mid-90s percent accurate for T-staging and high 80s to 90% accurate for nodal staging of rectal cancer. — Conor Delaney (clinical) [Ep 2 · 13:37](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=817)
- Endoscopic ultrasound is only about 70% accurate for predicting nodal involvement in rectal cancer and is much more operator-dependent than MRI. — Conor Delaney (clinical) [Ep 2 · 13:56](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=836)
- MRI is particularly good at distinguishing T3 and T4 tumors and assessing circumferential resection margins, though less accurate at distinguishing T1 from T2. — Conor Delaney (clinical) [Ep 2 · 10:27](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=627)
- Historical local recurrence rates for rectal cancer from good institutions were 20–38%, with some series up to 50%. — Conor Delaney (epidemiological) [Ep 2 · 10:51](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=651)
- With optimized surgery and imaging, local recurrence rates for rectal cancer should now be under 10%; Cleveland Clinic's rate over the last 10 years was about 3%. — Conor Delaney (epidemiological) [Ep 2 · 11:04](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=664)
- Circumferential resection margin is the most important margin (or many think more important than distal margin) for preventing local recurrence in rectal cancer. — Conor Delaney (clinical) [Ep 2 · 10:39](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=639)
- Total mesorectal excision (TME) can be performed with about 5 mL of blood loss because it follows a bloodless embryological plane; bleeding indicates wrong plane unless deliberately outside TME plane. — Conor Delaney (clinical) [Ep 2 · 12:24](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=744)
- Neoadjuvant therapy for rectal cancer is indicated for T3 tumors (outside the rectal wall) or node-positive disease. — Conor Delaney (guideline) [Ep 2 · 12:54](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=774)
- Stage 1 rectal cancer (node-negative, T1 or T2), particularly in the upper third of the rectum, does not require neoadjuvant therapy. — Conor Delaney (guideline) [Ep 2 · 13:18](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=798)
- Short-course radiation (5×5 Gy over 5 days, surgery 1–2 weeks later) is commonly used in Europe; long-course chemoradiation (40–45 Gy over 6 weeks with 6–8 week wait) is standard in the US. — Conor Delaney (guideline) [Ep 2 · 18:04](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1084)
- 25 Gy over a short period is radiotherapeutically equivalent to 40–45 Gy over a longer period, but long-course therapy may produce better tumor downstaging for bulky tumors. — Conor Delaney (clinical) [Ep 2 · 18:26](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1106)
- Transanal resection for rectal cancer is generally limited to T1 tumors less than one-third circumference and ideally less than 2 cm. — Conor Delaney (guideline) [Ep 2 · 14:35](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=875)
- Historical local recurrence rates for transanally excised rectal cancers were about 18%, remarkably consistent across multiple centers. — Conor Delaney (epidemiological) [Ep 2 · 14:51](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=891)
- Transanal endoscopic microsurgery (TEM) may produce better outcomes than traditional transanal excision, though it is unclear whether this is due to technology or improved surgical understanding. — Conor Delaney (opinion) [Ep 2 · 15:05](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=905)
- For young, curable patients, radical resection is generally favored over transanal resection; transanal resection is typically reserved for patients unfit for radical surgery or those who would require permanent stoma. — Conor Delaney (guideline) [Ep 2 · 15:27](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=927)
- For rectal cancer, full-thickness excision is required; ESD or EMR is never appropriate for proven cancer, only for benign polyps. — Conor Delaney (clinical) [Ep 2 · 16:24](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=984)
- For colon cancer, at least 12 lymph nodes are required for adequate staging, though many surgeons aim for at least 16. — Conor Delaney (guideline) [Ep 2 · 19:51](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1191)
- High ligation of the inferior mesenteric artery (above the takeoff of the left colic artery) is standard for sigmoid colectomy, with protection of autonomic nerves to preserve sexual function. — Conor Delaney (clinical) [Ep 2 · 19:59](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1199)
- Total mesocolic excision for colon cancer should be performed with about 5 mL of blood loss in the embryological plane between retroperitoneal peritoneum (Toldt's fascia) and mesocolic peritoneum. — Conor Delaney (clinical) [Ep 2 · 20:18](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1218)
- Scandinavian data showed local recurrence rates for colon cancer were even higher than for rectal cancer (high 20s%) before focus on complete mesocolic excision technique. — Conor Delaney (epidemiological) [Ep 2 · 20:48](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1248)
- For cecal or ileocecal valve tumors, 10 cm of small bowel should be resected; for mid-ascending colon tumors, 5 cm of small bowel is adequate. — Conor Delaney (clinical) [Ep 2 · 23:12](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1392)
- Extracorporeal stapled anastomosis for right hemicolectomy achieved a leak rate of 0.8% over 1000 cases at Cleveland Clinic. — Conor Delaney (epidemiological) [Ep 2 · 24:00](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1440)
- Genetic assessment is indicated for colorectal cancer patients with Bethesda criteria risk factors, cancer under age 40, first-degree relatives with cancer, or multiple cancers in the family. — Conor Delaney (guideline) [Ep 2 · 24:56](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1496)
- Genetic diagnosis affects both family screening recommendations and surgical approach; patients with hereditary syndromes may require subtotal colectomy or proctocolectomy rather than segmental resection. — Conor Delaney (clinical) [Ep 2 · 25:33](https://team.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1533)
- Telestration reduces errors by more than 30% in surgical telementoring (clinical) [Ep 1 · 4:00](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=240)
- Skype for Business is approved by Scandinavian authorities for medical use but not yet HIPAA compliant in the United States (guideline) [Ep 1 · 8:00](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=480)
- Most remote desktop systems require a separate line for audio, which can be a challenge (clinical) [Ep 1 · 15:00](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=900)
- The STAR platform can be used for open surgery but not yet for laparoscopic surgery (clinical) [Ep 1 · 19:40](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=1180)
- When using laparoscopic video for telestration, if the camera holder moves the camera, the telestration lines move and no longer correspond to the anatomy (clinical) [Ep 1 · 23:40](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=1420)
- Telementoring is challenging time-wise because watching someone perform a 3-hour operation requires significant mentor availability unless structured as on-call consultation (opinion) [Ep 1 · 23:00](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=1380)
- Surgical telementoring requires three elements: a known mentor-mentee relationship, an educational framework (not teleconsultation), and local surgical expertise to manage the disease process (guideline) [Ep 1 · 27:30](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=1650)
- Integrating telementoring into structured training programs may be one of the keys to successful implementation (opinion) [Ep 1 · 23:20](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=1400)
- Telementoring is particularly valuable in geographically large areas like Norway, Africa, and the US where surgeons may not have enough experience with specific techniques (opinion) [Ep 1 · 22:20](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=1340)
- Educational experts outside surgery can help inform best practices for teaching over distance and using telementoring platforms (opinion) [Ep 1 · 27:00](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=1620)
- The marginal cost per patient in the decision tree model was cheaper with regionalized care compared to local care — Ira Leeds (clinical) [Ep 3 · 1:04](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=64)
- Clinical outcomes showed a mortality benefit in the regionalized arm versus the local arm, creating economic dominance where costs are cheaper in the same arm with better clinical benefit — Ira Leeds (clinical) [Ep 3 · 1:04](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=64)
- Sensitivity analysis of over 10,000 scenarios showed nearly all scenarios clustered in quadrant 4, where regionalization is the dominant strategy with both lower costs and better effectiveness than local care — Ira Leeds (clinical) [Ep 3 · 1:04](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=64)
- Cost-effectiveness methodologies are particularly helpful for population level decision making, averaging expectations and outcomes across all patients rather than individual patient selection — Ira Leeds (opinion) [Ep 3 · 1:04](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=64)
- Regionalized rectal cancer surgery is the dominant cost-effective strategy compared to local rectal cancer surgery — Ira Leeds (clinical) [Ep 3 · 1:04](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=64)
- Local rectal cancer surgery is rarely cost-effective in this model under even the most extreme sensitivity scenarios — Ira Leeds (clinical) [Ep 3 · 1:04](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=64)
- Cost-effectiveness analysis is based on assumptions that can sway results dramatically (opinion) [Ep 3 · 5:39](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=339)
- The model ran through 10,000 iterations with very wide confidence bars around each estimate to test robustness — Ira Leeds (clinical) [Ep 3 · 7:00](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=420)
- In 97.8% of the model scenarios, the regionalized case won out over local care when including downstream costs of cancer recurrence and early death — Ira Leeds (clinical) [Ep 3 · 9:44](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=584)
- High-volume centers using robotics will increase the cost per case significantly — Todd Ponsky (opinion) [Ep 3 · 8:52](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=532)
- Healthcare is moving toward de-regionalization with home monitoring, telementoring, and bringing healthcare to the patient rather than patient to centers (opinion) [Ep 3 · 10:41](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=641)
- In some healthcare systems, a community oncologist an hour and a half away presents every single rectal cancer case to an entire board across the entire system — Ira Leeds (clinical) [Ep 3 · 11:27](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=687)
- The data is not good enough yet to support a regionalized decentralized model using technology to export expertise — Ira Leeds (opinion) [Ep 3 · 11:27](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=687)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- A Houston-Melbourne collaboration successfully telementored 25 retroperitoneoscopic adrenalectomy cases using Skype, concluding it is a feasible platform — The host summarizing the discussion [Ep 1 · 9:40](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=580)
- The first published study on remote desktop systems for surgical telementoring was by Gambadero and Marcus in London in 2007 for laparoscopic gynecological surgery — The host summarizing the discussion [Ep 1 · 13:00](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=780)
- The OR Network platform has telementored 500 laparoscopic procedures from the United Kingdom to Tanzania — The host summarizing the discussion [Ep 1 · 18:00](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=1080)
- The STAR (System for Telementoring with Augmented Reality) platform allows participants to complete tasks with fewer placement errors and fewer focus shifts by overlaying transparent telestration directly on the surgical field — The host summarizing the discussion [Ep 1 · 19:00](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=1140)
- Indian colleagues created a surgical telementoring setup using a repurposed laparoscopic camera for video capture at a cost of only $400-500 — The host summarizing the discussion [Ep 1 · 20:00](https://team.globalcastmd.com/watch/surgical-telementoring-emerging-technologies-comparative-technology-in-966?t=1200)
- Regionalization of rectal cancer surgery increases lymph node yield — Ira Leeds summarizing the discussion [Ep 3 · 1:04](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=64)
- Regionalization of rectal cancer surgery increases the use of neoadjuvant therapy — Ira Leeds summarizing the discussion [Ep 3 · 1:04](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=64)
- Regionalization of rectal cancer surgery decreases 30 and 90-day mortality — Ira Leeds summarizing the discussion [Ep 3 · 1:04](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=64)
- Regionalization of rectal cancer surgery is associated with a 34% decrease in 5-year mortality — Ira Leeds summarizing the discussion [Ep 3 · 1:04](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=64)
- More than 3 times the number of patients would have to travel more than 50 miles to achieve regionalized care compared to local care — Ira Leeds summarizing the discussion [Ep 3 · 1:04](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=64)
- Patients who travel for regionalized rectal cancer surgery tend to be more white and more privately insured, raising healthcare equity issues — Ira Leeds summarizing the discussion [Ep 3 · 1:04](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=64)
- Regionalized care per case is more expensive than local care when looking at case costs alone — Ira Leeds summarizing the discussion [Ep 3 · 9:44](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=584)
- New York State historically published individual surgeon outcomes for heart surgery in newspapers — Todd Ponsky summarizing the discussion [Ep 3 · 8:52](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=532)
- Many argue that regionalization benefits come from the system of care rather than one amazing surgeon with greatest experience — Ira Leeds summarizing the discussion [Ep 3 · 9:44](https://team.globalcastmd.com/watch/best-of-the-best-gen-surg-how-far-is-too-far-cost-effectiveness-analysis-of-regionalized-rectal-cancer-surgery-dr-leeds-5858?t=584)

## Changelog
- Sep 17: Published again automatically — condition is back above threshold
- Sep 17: 2 items added automatically
- Sep 17: 3 items no longer name rectal cancer
- Sep 12: Unpublished automatically — folded or below threshold
- Sep 7: 4 items added automatically

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