Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm

Martling, Anna; Holm, Torbjörn; Rutqvist, Lars‐Erik; Moran, Brendan; Heald, R. J.; Cedermark, Björn

doi:10.1016/s0140-6736(00)02469-7

Cited by 709 publications

(206 citation statements)

References 19 publications

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“…Other institutions showed that optimal TME quality can be achieved by individual training after instruction by TME trained surgeons [20]. All operations except for urgent surgery were supervised by surgeons being experienced in TME surgery for several years.…”

Section: Discussionmentioning

confidence: 99%

“…There may be further discussion about the exact distance for negative resections margins, but the optimal technique to obtain free resection margins is total mesorectal excision since it has been shown that TME achieves a negative resection margin in up to 96% of resected specimen [20]. These results were confirmed by Nagtegaal et al They analysed the importance of TME to obtain free circumferential resection margins showing that in patients with positive CRM the rate of incomplete TME was 44% while in patients with negative CRM the rate of incomplete TME was only 11%.…”

Section: Discussionmentioning

confidence: 99%

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TME quality in rectal cancer surgery

et al. 2010

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Background The concept of total mesorectal excision has revolutionised rectal cancer surgery. TME reduces the rate of local recurrence and tumour associated mortality. However, in clinical trials only 50% of the removed rectal tumours have an optimal TME quality. Patients: During a period of 36 months we performed 103 rectal resections. The majority of patients (76%; 78/103) received an anterior resection. The remaining patients underwent either abdominoperineal resection (16%; 17/103), Hartmann's procedure (6%; 6/103) or colectomy (2%; 2/103). Results In 90% (93/103) TME quality control could be performed. 99% (92/93) of resected tumours had optimal TME quality. In 1% (1/93) the mesorectum was nearly complete. None of the removed tumours had an incomplete mesorectum. In 98% (91/93) the circumferential resection margin was negative. Major surgical complications occurred in 17% (18/103). 5% (4/78) of patients with anterior resection had anastomotic leakage. 17% (17/103) developed wound infections. Mortality after elective surgery was 4% (4/95). Conclusion Optimal TME quality results can be achieved in all stages of rectal cancer with a rate of morbidity and mortality comparable to the results from the literature. Future studies should evaluate outcome and local recurrence in accordance to the degree of TME quality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

TME quality in rectal cancer surgery

et al. 2010

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“…Recently, even better survival figures have been reported in some Swedish healthcare regions (2,3). This marked survival improvement for rectal, but not for colon cancer, has also been noticed in the most recent update of the Swedish Cancer Registry (Epidemiologiskt centrum, June 2001).…”

mentioning

confidence: 80%

“…2 Outpatient attendees only reported. 3 Residual and recurrent disease related to the length of follow-up. 4 Autopsy series only reported.…”

Section: Radiotherapy In Resectable Rectal Cancermentioning

confidence: 99%

“…The term 'total mesorectal excision' (TME) is often used for this type of surgery, although the entire mesorectum is not always excised in high rectal cancers. Concentration of rectal cancer surgery to a colorectal cancer unit and extensive surgical training programmes have also resulted in low local failure rates (approximately 10 Á/15% after 2 Á/5 years) in unselected Swedish patient populations (3,54) and in Norway (55). Several individual hospitals have also reported low recurrence rates after having introduced the TME concept (e.g.…”

Section: Radiotherapy In Resectable Rectal Cancermentioning

confidence: 99%

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A Systematic Overview of Radiation Therapy Effects in Rectal Cancer

et al. 2003

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A Novel Risk-Adjusted Nomogram for Rectal Cancer Surgery Outcomes

Russell

You

et al. 2013

JAMA Surg

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Context Circumferential resection margin is the primary determinant of local recurrence and a major factor in survival in rectal cancer. Neither chemotherapy nor chemoradiation compensates for a positive margin. Objective To identify treatment-related factors associated with hospital margin-positive resection and to develop a tool that could be used by individual hospitals to assess their outcomes based on their unique mix of patient and tumor characteristics. Design Retrospective review of the National Cancer Data Base, 1998–2007. Settings Community and academic/research hospitals. Patients Histologically confirmed localized rectal/rectosigmoid adenocarcinoma. Outcome measures Rate of margin positivity determined and adjusted for patient- and tumor-related factors to calculate expected margin positivity per hospital. An observed/expected ratio was calculated based on patient and tumor factors to identify treatment associated variation. Results Overall margin-positive resection rate was 5.2%. Patients with positive margins were more likely to be older, male, and African American; not have private insurance; and have their cancer diagnosed later in the study period. Associated tumor factors include rectal location, higher American Joint Committee on Cancer stage, signet/mucinous histology, and poor/undifferentiated grade. Among hospitals that were significantly low outliers, 47% were comprehensive community hospitals and 43.9% were academic/research hospitals; of those that were significantly high outliers, 52.3% were comprehensive community hospitals and 17.8% were academic/research hospitals. High-volume centers made up 80% of significantly low-outlier hospitals and 17% of significantly high outliers. Rates of chemotherapy and radiation were similar, but low-outlier hospitals gave more neoadjuvant radiation (26.3% vs 17%). Conclusions After adjustment for patient and tumor factors we identified both low and high outliers for margin positivity at resection as well as potentially modifiable risk factors. The nomogram created in this model allows evaluation of observed and expected event rates for individual hospitals, providing a hospital self-assessment tool for identifying targets for improvement.

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Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm

Cited by 709 publications

References 19 publications

TME quality in rectal cancer surgery

TME quality in rectal cancer surgery

A Systematic Overview of Radiation Therapy Effects in Rectal Cancer

A Novel Risk-Adjusted Nomogram for Rectal Cancer Surgery Outcomes

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