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Colorectal Cancer Surgery and Pathology List Serv


Cancer Care Ontario's Surgical Oncology Program launched the Colorectal Cancer (CRC) Surgery and Pathology List Serv as a knowledge exchange strategy for a CRC clinical practice guideline (CPG), entitled: 'Optimization of Surgical and Pathological Quality Performance in Radical Surgery for Colon and Rectal Cancer: Margins and Lymph Nodes', which can be accessed at: http://www.cancercare.on.ca/toolbox/qualityguidelines/clin-program/surgery-ebs/. The List Serv provided an online multidisciplinary platform for physicians to improve their knowledge in the management of CRC by discussing quality issues related to the CPG.

The List Serv was modeled after the Canadian Association of General Surgeon's Evidence-Based Reviews in Surgery, with the initiative offered at no charge to clinicians and administrators. In addition, it was an accredited group learning activity, as defined by the Maintenance of Certification program of The Royal College of Physicians and Surgeons of Canada, approved by the University of Toronto.

From September 2008 to March 2009, six clinical scenarios were posted on the CRC List Serv, including:

  1. Locally advanced colon cancer with other organ involvement,
  2. Staging and management of rectal cancer,
  3. Locally advanced rectal cancer,
  4. Role of reconstruction following resection of rectosigmoid cancer,
  5. assessing the quality of surgery and pathology of rectal cancer, and
  6. indicators and initiatives to improve quality of rectal surgery and pathology

Participants from various disciplines involved in the care of CRC patients were invited to participate. All fourteen Local Health Integration Networks (LHINs) across the province of Ontario were represented. A multidisciplinary group of clinical experts were also nominated for each clinical scenario to address and encourage comments from the participants. The participants provided comments and/or feedback by sending an email to the List Serv, with an average of 34 comments posted for each scenario.

List Serv discussions generated general agreement on guideline recommendations. The number of List Serv participants steadily increased after each clinical scenario; however, the number of postings varied from scenario to scenario. Based on a qualitative analysis, salient issues identified included: importance of pre-operative imaging of colon cancer, staging of rectal cancer, role of neoadjuvant therapy and the Quirke method of processing specimens.

Example of List Serv

1.0 List Serv: Participants and Postings

Each Clinical Scenario was posted on the List Serv for three weeks. Participants were given one week to discuss the management of the patient and other issues, and then relevant recommendations from the guideline as well as supporting evidence. Discussion subsequently continued for another week. Topics for the clinical scenarios included: locally advanced colon cancer with other organ involvement, management of rectal cancer, and indicators and initiatives to improving quality of rectal (colorectal) surgery and pathology.

List Serv subscriptions increased steadily after each clinical scenario; however, the number of postings varied from scenario to scenario. An average of 34 comments were posted for each scenario, with a range from 12 postings per scenario to 52 postings per scenario.

A total of 253 participants subscribed to the List Serv, including: 127 surgeons, 33 pathologists, 6 radiation oncologists, 11 radiologists, 6 medical oncologists, 40 surgery and pathology trainees, and 30 administrators.

2.0 List Serv: Evaluation Results

The CRC Summary List Serv evaluation results were as follows; Satisfaction with the overall List Serv initiative, format (i.e. email), and case presentations were reported by respondents as 78.3%, 69.6% and 73.9% respectively. Improved culture of collaboration between various disciplines (85.1%) and awareness of new/different practices in Ontario (74.5%) were some of the benefits cited by List Serv participants. Participants also reported they shared comments with colleagues on the List Serv (73.5%) and incorporated input into clinical practice (95.9%). A majority stated the List Serv increased their knowledge of the surgery (75.0%) and pathology (85.4%) guideline recommendations.

List Serv participants provided positive anecdotal feedback, including:

  • 'It is a great learning tool and definitely creates a community of practice'
  • 'As a result of the scenario, we had a departmental meeting to discuss the handling of rectal specimens and reviewed current Cancer Care Ontario guidelines'
  • 'I've learned the importance of a multidisciplinary approach, especially for cases involving rectal cancer'

The CRC List Serv is a feasible knowledge exchange strategy with high physician satisfaction and knowledge awareness.


  1. Cancer Care Ontario, Surgical Oncology Program. http://www.cancercare.on.ca/ocs/clinicalprogs/surgonc/
  2. Nhan C, Driman DK, Smith AJ, Hunter A, McLeod RS. Colorectal Cancer (CRC) Surgery and Pathology List Serv: A Clinical Practice Guideline (CPG): Knowledge Exchange Strategy. The Canadian Journal of Surgery, 2009; 52 Supplement [in press].