Benchmarking Trial Between France and Australia Comparing Management of Primary Rectal Cancer Beyond TME (Total Mesorectum Excision) and Locally Recurrent Rectal Cancer (PELVICARE)

• Clinical resection rates in both countries [ Time Frame: 12 months ]
  Expressed as a percentage and corresponding to the ratio between the number of patients operated and the number of patients discussed in colorectal MDT meetings for PRC-bTME and LRRC. These rates will be expressed separately in each country and compared.
  
  

• Concordance rate of operative decisions between France and Australia [ Time Frame: 6 months, 12 months ]
  An analysis of concordance between French and Australian operative decisions will be carried out through the radiological (or theoretical) resectability rate, expressed as a percentage and corresponding, after blind inter-country reading of pelvic MRIs, to the ratio between the number of patients judged to have resectable tumours and the number of all MRI re-reading.
  
  
• R0 resection rate [ Time Frame: 12 months ]
  Expressed as a percentage and corresponding to the report of the number of patients operated with a surgical resection margin > 1mm on the number of operated patients
  
  
• Disease Free Survival [ Time Frame: 12 months ]
  
• Overall Survival [ Time Frame: 12 months ]
  
• Post-operative morbidity and mortality rates [ Time Frame: 30 days ]
  Evaluated according to the Dindo scale for patients in curative intent treatment. Grade I was any deviation from the normal postoperative course, Grade II included pharmacological treatment, Grade III was complications requiring surgical, endoscopic or radiological intervention, Grade IV included life-threatening complications requiring intensive care unit management and Grade V complications caused postoperative death.
  
  
• Quality of life questionnaire [ Time Frame: 6 months, 12 months ]
  According to MOS SF-36 score and FACT-C score
  
  
• Stress level score [ Time Frame: 6 months, 12 months ]
  According to distress thermometer (score range from 0 [no distress] to 10 [extreme distress])
  
  
• Analyses of semi-structured interviews [ Time Frame: 12 months ]
  Occurrence and cooccurrence computation of thematic contents (frequency and Chi square analyses) ; similarity analyses (maximum three with connectedness and similarity index computations, identification of the central and peripheral representation cores in each occupational group)
  
  

This research project rests on the comparison between two contrasting countries with regards to the care management of PRC-bTME (Primary rectal cancer beyond total mesorectum excision planes) and LRRC (Locally recurrent rectal cancer), France and Australia. Regarding its healthcare system for patients with PRC-bTME and LRRC, Australia equipped itself with a veritable policy of centralisation and clinical pathway, appearing as an international referent country in this surgical field.

The main hypotheses of research are that these differences rest on individual and collective representation of disease, organisations, structures, clinical pathway and care management.

Benchmarking of clinical practices is a process that consists of a structured comparison and the sharing of good practices of clinical care; it is based on a quality of care assessment and allows to fit into an approach of continuous improvement of this quality of care.