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Time trends, improvements and national auditing of rectal cancer management over an 18‐year period
Author(s) -
Kodeda K.,
Johansson R.,
Zar N.,
Birgisson H.,
Dahlberg M.,
Skullman S.,
Lindmark G.,
Glimelius B.,
Påhlman L.,
Martling A.
Publication year - 2015
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13060
Subject(s) - medicine , colorectal cancer , audit , cancer registry , cohort , total mesorectal excision , population , cancer , cohort study , radiation therapy , chemoradiotherapy , relative survival , surgery , general surgery , environmental health , management , economics
Aim The main aims were to explore time trends in the management and outcome of patients with rectal cancer in a national cohort and to evaluate the possible impact of national auditing on overall outcomes. A secondary aim was to provide population‐based data for appraisal of external validity in selected patient series. Method Data from the Swedish ColoRectal Cancer Registry with virtually complete national coverage were utilized in this cohort study on 29 925 patients with rectal cancer diagnosed between 1995 and 2012. Of eligible patients, nine were excluded. Results During the study period, overall, relative and disease‐free survival increased. Postoperative mortality after 30 and 90 days decreased to 1.7% and 2.9%. The 5‐year local recurrence rate dropped to 5.0%. Resection margins improved, as did peri‐operative blood loss despite more multivisceral resections being performed. Fewer patients underwent palliative resection and the proportion of non‐operated patients increased. The proportions of temporary and permanent stoma formation increased. Preoperative radiotherapy and chemoradiotherapy became more common as did multidisciplinary team conferences. Variability in rectal cancer management between healthcare regions diminished over time when new aspects of patient care were audited. Conclusion There have been substantial changes over time in the management of patients with rectal cancer, reflected in improved outcome. Much indirect evidence indicates that auditing matters, but without a control group it is not possible to draw firm conclusions regarding the possible impact of a quality control registry on faster shifts in time trends, decreased variability and improvements. Registry data were made available for reference.