Prospektive Multizenterstudien “Kolon-/Rektumkarzinome” als flächendeckende chirurgische Qualitätssicherung

Abstract

Surgical quality control in the form of prospective multicentre observational studies make possible the analysis of the therapeutic situation of a surgical disease under quality assurance aspects. At the same time, the comprehensive data material available will serve the specific planning of prospective randomized studies. With the aid of the present study, a basis for a thorough and complete evaluation of colorectal carcinoma has been created.

Multimodal Perioperative Rehabilitation in Elective Conventional Resection of Colonic Cancer: Results from the German Multicenter Quality Assurance Program ‘Fast-Track Colon II’

“…Despite advanced age and a high-risk profile of the patient population, general morbidity was low (13.2%) and surgical morbidity (20.4%) acceptable. These data confirm previous observations from individual institutions [2,8,9,10,11,12,14,15,16,17], according to which multimodal perioperative care is safe and feasible for patients undergoing elective colonic surgery compared to data from other multicenter studies from Europe and the United States applying ‘traditional’ perioperative treatment [18,19,20,21]. Our results endorse outcomes from small randomized and controlled studies that demonstrated reduction of postoperative general morbidity with fast-track rehabilitation compared to traditional perioperative care [12].…”

“…Several forms of bias make a comparison of data from different studies impossible, although it is remarkable that none of the traditional registries yielded general morbidity rates of less than 15%. General complications occurred in 622 (27.1%) of 2,293 WGCRC patients with colonic cancer [21] but only in 13.2% of FTCII patients. Pneumonia and atelectasis were observed in 11.3% of patients with traditional perioperative care (WGCRC colon [21]) but only 4.9% of FTCII patients receiving multimodal therapy.…”

“…General complications occurred in 622 (27.1%) of 2,293 WGCRC patients with colonic cancer [21] but only in 13.2% of FTCII patients. Pneumonia and atelectasis were observed in 11.3% of patients with traditional perioperative care (WGCRC colon [21]) but only 4.9% of FTCII patients receiving multimodal therapy. Simultaneously, the incidence of urinary tract infection was reduced from 4.2% (WGCRC colon) to 1.7% (FTCII).…”

“…However, data from previous German multicenter quality assurance programs including large patient numbers are available, and a cautious comparison of these data with the results of the FTCII database seems to be reasonable. The Working Group ‘Colon/Rectum Carcinoma’ (WGCRC) prospectively observed the perioperative course of 2,293 patients undergoing open colonic resection for cancer in 75 German surgical departments from 2000 to 2002 [21]. Multimodal perioperative care had not been established in any participating hospital at that time, thus WGCRC data were achieved by traditional perioperative care.…”

Frühpostoperative Ergebnisqualität in der Chirurgie des Rektumkarzinoms in Abhängigkeit von der Fallzahl in der Klinik

“…Diese ist als externe Qualitätssicherungsmaßnah-me Bestandteil der chirurgischen Versorgungsforschung und erfasst das gesamte Klinikspektrum. Ziel der Qualitätssiche-rungsstudie ist die Darstellung der Versorgungssituation und die Erforschung von Ursachen qualitativer Defizite als Ausgangspunkt für Maßnahmen, die der Verbesserung der Ergebnisqualität dienen [1][2][3]. Zahlreiche klinische Studien konnten die Einflussfaktoren «Chirurg» und «versorgende Klinik» als unabhängige Prognosefaktoren für das Outcome (Ergebnisqualität) nach kurativer Tumorresektion beim Rektumkarzinom ausweisen und dabei eine Korrelation zur Fallzahl für den einzelnen Chirurgen (surgeon volume) und die Klinik (hospital volume) herstellen [4].…”