International evaluation of circumferential resection margins after rectal cancer resection: insights from the Swedish and Dutch audits

Detering, Robin; Saraste, Deborah; Babberich, Michael P.M. de Neree tot; Dekker, Jan Willem T.; Wouters, M.W.J.M.; Geloven, A. A. W. van; Bemelman, Willem A.; Tanis, Pieter J.; Westerterp, Marinke; Aalbers, Arend G. J.; Boer, Frank C. den; Breukink, Stéphanie O.; Coene, P. P. L. O.; Doornebosch, Pascal G.; Gelderblom, Hans; Karsten, Tom; Ledeboer, Michel; Manusama, Eric R.; Marijnen, Corrie A.M.; Nagtegaal, Irıs D.; Peeters, Koen; Tollenaar, Rob A.E.M.; Velde, C. van de; Wagner, Anja; Westreenen, Erik van

doi:10.1111/codi.14903

Cited by 11 publications

(12 citation statements)

References 32 publications

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“…In line with a previous collaborative project, we found that Dutch and Swedish patients had different patient-, tumour-, and surgical characteristics [8]. In addition, cTand cN-stages in colon cancer were more often defined by Swedish radiologists, despite the previously published unreliability of CT imaging for this purpose [48,49].…”

Section: Discussionsupporting

confidence: 83%

“…Rectal cancer procedures were categorized as anterior resection with primary anastomosis with or without diverting stoma, Hartmann's procedure, and abdominoperineal excision (APE). For the evaluation of hospital volume, hospitals were categorized into low, low-intermediate, intermediate-high, and high volume hospitals, which was defined as < 30, 30-60, 61-90, and > 90 for colon cancer resections and < 12, 12-25, 26-50, > 50 for rectal cancer resection (as defined by Detering et al [8]).…”

Section: Data Extraction Outcomes and Definitionsmentioning

confidence: 99%

“…At an international level, significant differences in colorectal cancer care exist between countries. Therefore, international comparisons of treatment strategies and results with data from national audits can provide valuable insights into national performance and, as a consequence, potential areas for country-specific evaluation and improvement [6][7][8].…”

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confidence: 99%

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National differences in implementation of minimally invasive surgery for colorectal cancer and the influence on short-term outcomes

et al. 2022

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Background The timing and degree of implementation of minimally invasive surgery (MIS) for colorectal cancer vary among countries. Insights in national differences regarding implementation of new surgical techniques and the effect on postoperative outcomes are important for quality assurance, can show potential areas for country-specific improvement, and might be illustrative and supportive for similar implementation programs in other countries. Therefore, this study aimed to evaluate differences in patient selection, applied techniques, and results of minimal invasive surgery for colorectal cancer between the Netherlands and Sweden. Methods Patients who underwent elective minimally invasive surgery for T1-3 colon or rectal cancer (2012–2018) registered in the Dutch ColoRectal Audit or Swedish ColoRectal Cancer Registry were included. Time trends in the application of MIS were determined. Outcomes were compared for time periods with a similar level of MIS implementation (Netherlands 2012–2013 versus Sweden 2017–2018). Multilevel analyses were performed to identify factors associated with adverse short-term outcomes. Results A total of 46,095 Dutch and 8,819 Swedish patients undergoing MIS for colorectal cancer were included. In Sweden, MIS implementation was approximately 5 years later than in the Netherlands, with more robotic surgery and lower volumes per hospital. Although conversion rates were higher in Sweden, oncological and surgical outcomes were comparable. MIS in the Netherlands for the years 2012–2013 resulted in a higher reoperation rate for colon cancer and a higher readmission rate but lower non-surgical complication rates for rectal cancer if compared with MIS in Sweden during 2017–2018. Conclusion This study showed that the implementation of MIS for colorectal cancer occurred later in Sweden than the Netherlands, with comparable outcomes despite lower volumes. Our study demonstrates that new surgical techniques can be implemented at a national level in a controlled and safe way, with thorough quality assurance.

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Section: Discussionsupporting

confidence: 83%

Section: Data Extraction Outcomes and Definitionsmentioning

confidence: 99%

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National differences in implementation of minimally invasive surgery for colorectal cancer and the influence on short-term outcomes

et al. 2022

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“…The overall rate of APR to restorative rectal resection was relatively high but comparable to recent population-based studies, with approximately one-third of all rectal cancer resections being APR. Incidence of APR for rectal cancer varies in the literature from 18% to 37% [3,[9][10][11][12]. Moreover, there have been reported instances of much higher APR rates in specific populations [13].…”

Section: Discussionmentioning

confidence: 99%

Abdominoperineal excision in Australasia: clinical outcomes, predictive factors and recent trends of nonrestorative rectal cancer surgery

et al. 2020

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Aim The decision to perform an abdominoperineal excision (APR) rather than restorative bowel resection relies on a number of clinical factors. There remains great variability in APR rates internationally. The aim of this study was to demonstrate trends of APR surgery in low rectal cancer (< 6 cm from the anal verge) in Australasia and identify predictors of nonrestoration. Method This study reviewed a prospectively maintained colorectal registrythe Binational Colorectal Cancer Audit (BCCA)from general/colorectal surgical units across Australia and New Zealand. Data were analysed to determine factors predictive of nonrestorative resection. Patients were analysed based on the presence (control) or absence (comparison) of a primary anastomosis. Results Of 3628 patients with rectal cancer, 2096 were diagnosed with low rectal cancer between 2007 and 2017. The incidence of APR remained constant over the study period, with 58% of all resections of low rectal cancer being APR. The majority of resections were performed by consultants in urban hospitals (86% vs 14%). Tumours ≤ 3 cm from the anal verge, T4, M1 disease and neoadjuvant therapy were the greatest predictors of APR (P < 0.001). A significantly increased rate of restorative surgery was observed in public hospital settings (59% vs 41%, P < 0.05). The rate of positive circumferential resection margin (CRM) was 7.95%, with significantly increased rates in patients undergoing APR (12.2% vs 6.2%, P < 0.001). CRM positivity was increased in open approaches, T4, N2 and M1 staged disease and in an emergency/urgent setting (P < 0.001 and P < 0.045, respectively). Significantly increased wound and pulmonary complications were observed in the APR cohort (P < 0.01). Conclusion The rates of APR in Australia and New Zealand remain high but are comparable to international figures, with one-third of rectal cancers being treated by APR. The main determinants of APR are tumour height, T stage and neoadjuvant therapy requirement. CRM positivity was higher in APR patients.

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“…In this issue, Detering et al . [4] used the colorectal cancer audits from Sweden and the Netherlands to examine factors associated with positive circumferential resection margins (CRM) over five years. CRM is chosen as a quality indicator; a negative margin indicates the achievement of curative resection, and it is associated with lower morbidity, mortality and improved post‐operative quality of life [4].…”

mentioning

confidence: 99%