Nationwide quality assurance of rectal cancer treatment

Wibe, Arne; Carlsen, Erik; Dahl, Olav; Weedon‐Fekjær, Harald; Hestvik, Unn E.; Wiig, Johan N.

doi:10.1111/j.1463-1318.2005.00924.x

Cited by 64 publications

(58 citation statements)

References 18 publications

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“…In our study, both the T and N categories significantly predicted for a higher recurrence rate [22][23][24][25]. In conclusion, the local recurrence rate should be used as an important quality indicator in rectal cancer surgery because it is a very sensitive parameter determining the surgeons' accuracy, i.e., the correct performance of the TME technique [10,12,27,28].…”

Section: Discussionmentioning

confidence: 91%

“…As evidence suggests that training is a prerequisite to obtain good results in surgeons' hands; in the last years, many countries have focused on improvements in the training of rectal surgery [8][9][10]. For instance, Wibe et al [10] performed a prospective study to assess the influence of educational programs and training courses in Norway. They verified that the prognosis of rectal cancer patients was significantly improved by the increased organizational focus on rectal cancer treatment with a significant reduction of local recurrence [10].…”

Section: Introductionmentioning

confidence: 99%

“…For instance, Wibe et al [10] performed a prospective study to assess the influence of educational programs and training courses in Norway. They verified that the prognosis of rectal cancer patients was significantly improved by the increased organizational focus on rectal cancer treatment with a significant reduction of local recurrence [10].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of quality indicators following implementation of total mesorectal excision in primarily resected rectal cancer changed future management

Schneider

Vallböhmer

Ploenes

et al. 2011

Int J Colorectal Dis

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Background and aims We evaluated the outcome of primarily resected rectal cancer patients immediately after the implementation of total meserectal excision (TME) based on potential quality indicators. Patients and methods Following initial teaching of two staff surgeons (PMS and AHH) by RJ Heald, 164 consecutive patients were analyzed. The following quality indicators were evaluated: (a) frequency of local recurrence, (b) number of resected lymph nodes, (c) selection of operative technique depending on tumor localization, (d) use of a protective loop ileostomy, and (e) frequency and type of adjuvant therapy. Results Local recurrence rate was 8.5% after a minimum follow-up of 5 years. An increasing pT category (p<0.02) and the presence of lymph node metastases (pN+, p<0.05) were significantly associated with local recurrence rates. The number of resected lymph nodes was significantly associated with nodal metastases rate (p<0.02). Patients with distal third rectal cancer underwent significantly more often an abdominoperineal amputation (p<0.0001). Clinical course, but not the rate of anastomotic leakage (9.5%) itself was influenced by using a protective loop ileostomy. Fortytwo (29.7%) patients received adjuvant therapy; however, local recurrence rate was higher in patients with adjuvant chemo-/radiotherapy (14.2% vs. 6.1%). Conclusions The local recurrence rate of 8.5% demonstrates that through consequent implementation of TME excellent onclogical results can be achieved. The number of resected lymph nodes significantly influenced the pN category. The primary construction of a protective loop ileostomy after TME became standard. Neoadjuvant chemoradiation was systematically introduced in order to improve local tumor control and prevent abdominoperineal amputations. No conclusions can be drawn concerning adjuvant therapy.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of quality indicators following implementation of total mesorectal excision in primarily resected rectal cancer changed future management

Schneider

Vallböhmer

Ploenes

et al. 2011

Int J Colorectal Dis

View full text Add to dashboard Cite

show abstract

“…4. Penetration of tumor emboli into the mesorectal fascia due to vascular invasion was observed in 21.27% and 19.64% (LTME and OTME, respectively) 5. The probability of positivity of CRM as a result of defeat of the lymph nodes Gerota was 27.65% and 28.57% respectively.…”

Section: Resultsmentioning

confidence: 94%

“…According to a study in England, it was found that between preoperative MRI data and pathological histology of the removed material, the reliability is 90% [5,6,8].The aim of the research was to study some aspects of the pathohistological evaluation of the circular margin of resection in the laparoscopic and open method of total mesorectal excision.…”

Section: Introductionmentioning

confidence: 99%

Pathohistological Assessment of the Circular Margin of Resection During Total Mesorectal Excision, Conducted on The Malignant Formations of the Rectum

2017

International Journal of Research Studies in Science, Engineeri

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Prognostic factors and patterns of failure after surgery for T4 rectal cancer in the beyond total mesorectal excision era

Peacock

Waters

Bressel

et al. 2019

British Journal of Surgery

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Background: Despite advances in the rates of total mesorectal excision (TME) for rectal cancer surgery, decreased local recurrence rates and increased 5-year survival, there still exists large variation in the quality of treatment received. Up to 30 per cent of rectal cancers are locally advanced at presentation and approximately 5-10 per cent still breach the mesorectal plane and invade adjacent structures despite neoadjuvant therapy. With the evolution of extended resections for rectal cancers beyond the TME plane, proponents advocate that these resections should be performed only in specialist centres. The aim was to assess the prognostic factors and patterns of failure after beyond TME surgery for T4 rectal cancers.Methods: Data were collected from prospective databases at three high-volume institutions specializing in beyond TME surgery for T4 rectal cancers between 1990 and 2013. The primary outcome measures were overall survival, local recurrence and patterns of first failure. Results: Three hundred and sixty patients were identified. The negative resection margin (R0) rate was 82⋅8 per cent (298 patients) and the local recurrence rate was 12⋅5 per cent (45 patients). The type of surgical procedure (Hartmann's: hazard ratio (HR) 4⋅49, 95 per cent c.i. 1⋅99 to 10⋅14; P = 0⋅002) and lymphovascular invasion (HR 2⋅02, 1⋅08 to 3⋅77; P = 0⋅032) were independent predictors of local recurrence. The 5-year overall survival rate for all patients was 61 (95 per cent c.i. 55 to 67) per cent. The 5-year cumulative incidence of first failure was 8 per cent for local recurrence, 6 per cent for local and distant disease, and 18 per cent for distant disease.Conclusion: This study has demonstrated that a coordinated approach in specialist centres for beyond TME surgery can offer good oncological and long-term survival in patients with T4 rectal cancers.

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Nationwide quality assurance of rectal cancer treatment

Abstract: The prognosis for rectal cancer can be improved by increased organizational focus on rectal cancer treatment and by establishing a rectal cancer registry monitoring treatment standards throughout the country.

Cited by 64 publications

References 18 publications

Evaluation of quality indicators following implementation of total mesorectal excision in primarily resected rectal cancer changed future management

Evaluation of quality indicators following implementation of total mesorectal excision in primarily resected rectal cancer changed future management

Pathohistological Assessment of the Circular Margin of Resection During Total Mesorectal Excision, Conducted on The Malignant Formations of the Rectum

Prognostic factors and patterns of failure after surgery for T4 rectal cancer in the beyond total mesorectal excision era

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