Audit of colorectal cancer surgery by non-specialist surgeons

Singh, K.; Barry, M. K.; Ralston, Patricia A. S.; Henderson, Michael A.; McCormick, James; Walls, Andrew; Auld, C. D.

doi:10.1046/j.1365-2168.1997.02521.x

Cited by 26 publications

(19 citation statements)

References 31 publications

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“…Neoadjuvant radiotherapy was used from single institutions [1,[13][14][15][16][17][18][19][20][21][22][23] or are populationbased outcome studies [24][25][26][27][28][29][30]. Only a minority of studies are nationwide multi-institutional surveys [31][32][33].…”

Section: Resultsmentioning

confidence: 99%

Anastomotic leaks after anterior resection for mid and low rectal cancer: survey of the Italian Society of Colorectal Surgery

Asteria

Gagliardi²,

Pucciarelli³

et al. 2008

Tech Coloproctol

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univariate and multivariate analyses. Further analysis was conducted on patients with AL to identify factors correlated with gravity. Results There were 520 patients representing 64% of LAR for rectal cancer performed by SICCR members. The overall rate of AL was 15.2%. Mortality was 2.7% including 0.6% from AL. The incidence of AL was correlated with higher age (p<0.05), lower (<20 per year) centre case volume (p<0.05), obesity (p<0.05), malnutrition (p<0.01) and intraoperative contamination (p<0.05), and was lower in patients with a colonic J-pouch reservoir (p<0.05). In the multivariate analysis age, malnutrition and intraoperative contamination were independent predictors. The only predictor of severe (grade III/IV) AL was alcohol/smoking habits (p<0.05) while the absence of a diverting stoma was borderline significant (p<0.07). Conclusions Our retrospective survey identified several risk factors for AL. This survey was a necessary step to construct prospective interventional studies and to establish benchmark standards for outcome studies. Keywords Anastomotic leaks · Low anterior resection · Rectal cancer · Outcome studies IntroductionAnastomotic leakage (AL) is the most significant surgical complication following resection for rectal cancer [1], affecting perioperative mortality and possibly longterm survival [2,3]. The rate of AL after anterior resection (AR) varies from 3% to 19% [4][5][6][7][8][9][10][11], being clinically significant in 2.9-15.3% of patients. Mortality following a leak may be 6.0-39.3% [12]. Most of the reports of complications after surgery for colorectal cancer come Abstract Background The aim of the survey was to assess the incidence of anastomotic leaks (AL) and to identify risk factors predicting incidence and gravity of AL after low anterior resection (LAR) for rectal cancer performed by colorectal surgeons of the Italian Society of Colorectal Surgery (SICCR). Methods Information about patients with rectal cancers less than 12 cm from the anal verge who underwent LAR during 2005 was collected retrospectively. AL was classified as grade I to IV according to gravity. Fifteen clinical variables were examined by ing factors predicting the gravity of AL among patients with AL this classification was simplified to mild to moderate (grades 1 and 2) and severe (grades 3 and 4).Categorical variables were evaluated using either Fisher's exact test or Pearson's chi-squared test depending on sample size. Numerical variables were evaluated using Student's t-test. P values <0.05 were considered significant. All variables which were associated with the incidence or gravity of AL in the univariate analysis were entered into a multivariate logistic regression model. Data were analysed using the STATA program (release 8.0, 2003; Stata Corporation, College Station, TX). ResultsOf 108 centres contacted, 44 (40.7%) participated. Information on 682 patients with rectal cancer who had undergone surgery was collected. Sphincter-saving surgery was performed in 579 patients (84.9%). After excluding abdom...

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Section: Resultsmentioning

confidence: 99%

Anastomotic leaks after anterior resection for mid and low rectal cancer: survey of the Italian Society of Colorectal Surgery

Asteria

Gagliardi²,

Pucciarelli³

et al. 2008

Tech Coloproctol

View full text Add to dashboard Cite

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“…The recommendations originated from data suggesting that high workload (Schrag et al, 2002) or specialist (Birbeck et al, 2002;McArdle and Hole, 2002;Smith et al, 2003) doctors offered better outcomes than their low workload or generalist counterparts. Unfortunately, however, the evidence available to substantiate this theory is not conclusive (Kee et al, 1999;Parry et al, 1999) and, as a consequence, not all within the health service subscribe to the idea (Singh et al, 1997).…”

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confidence: 99%

The impact of the Calman–Hine report on the processes and outcomes of care for Yorkshire's colorectal cancer patients

et al. 2006

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The 1995 Calman -Hine plan outlined radical reform of the UK's cancer services with the aim of improving outcomes and reducing inequalities in NHS cancer care. Its main recommendation was to concentrate care into the hands of site-specialist, multi-disciplinary teams. This study aimed to determine if the implementation of Calman -Hine cancer teams was associated with improved processes and outcomes of care for colorectal cancer patients. The design included longitudinal survey of 13 colorectal cancer teams in Yorkshire and retrospective study of population-based data collected by the Northern and Yorkshire Cancer Registry and Information Service. The population was all colorectal cancer patients diagnosed and treated in Yorkshire between 1995 and 2000. The main outcome measures were: variations in the use of anterior resection and preoperative radiotherapy in rectal cancer, chemotherapy in Dukes stage C and D patients, and five-year survival. Using multilevel models, these outcomes were assessed in relation to measures of the extent of Calman -Hine implementation throughout the study period, namely: (i) each team's degree of adherence to the Manual of Cancer Service Standards (which outlines the specification of the 'ideal' colorectal cancer team) and (ii) the extent of site specialisation of each team's surgeons. Variation was observed in the extent to which the colorectal cancer teams in Yorkshire had conformed to the Calman -Hine recommendations. An increase in surgical site specialisation was associated with increased use of preoperative radiotherapy (OR ¼ 1.43, 95% CI ¼ 1.04 -1.98, Po0.04) and anterior resection (OR ¼ 1.43, 95% CI ¼ 1.16 -1.76, Po0.01) in rectal cancer patients. Increases in adherence to the Manual of Cancer Service Standards was associated with improved five-year survival after adjustment for the casemix factors of age, stage of disease, socioeconomic status and year of diagnosis, especially for colon cancer (HR ¼ 0.97, 95% CI ¼ 0.94 -0.99 Po0.01). There was a similar trend of improved survival in relation to increased surgical site specialisation for rectal cancer, although the effect was not statistically significant (HR ¼ 0.93, 95% CI ¼ 0.84 -1.03, P ¼ 0.15). In conclusion, the extent of implementation of the Calman -Hine report has been variable and its recommendations are associated with improvements in processes and outcomes of care for colorectal cancer patients.

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“…Experience and broader education may also be factors influencing the results in rectal cancer treatment. This view is supported by a study reporting that board‐certified colorectal surgeons have a lower in‐hospital mortality rate than other Institutional surgeons [ 22, 23]. In our opinion, specialization in rectal cancer treatment promotes quality not only by increased knowledge and skill in surgical technique but also for other reasons, e.g.…”

Section: Discussionmentioning

confidence: 99%

“…In this context, the role of both the surgeon and the hospital for the outcome of colorectal cancer treatment has been much debated [ 16–24]. Several studies have shown that the individual surgeon is a prognostic factor for the results, but it seems that skill is more important than case volume [ 18, 19, 23].…”

Section: Introductionmentioning

confidence: 99%