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Centralization of rectal cancer surgery improves long‐term survival
Author(s) -
Hosseinali Khani M.,
Smedh K.
Publication year - 2010
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/j.1463-1318.2009.02098.x
Subject(s) - medicine , total mesorectal excision , colorectal cancer , audit , multidisciplinary team , surgery , population , multivariate analysis , survival rate , radiation therapy , cancer , general surgery , nursing , management , environmental health , economics
Aim In 1996, rectal cancer surgery in the Swedish county of Västmanland was centralized to a single colorectal unit. At the same time, total mesorectal excision and multidisciplinary team meetings were introduced. The aim of this audit was to determine the long‐term results before and after centralization. Method All consecutive rectal cancer patients who underwent curative or palliative surgery at one of the county’s four hospitals between 1993 and 1996 ( n = 133, group 1) were compared with patients operated at the new centralized colorectal unit between 1996 and 1999 ( n = 144, group 2). Results Preoperative radiotherapy was common in both groups, but in group 2, it was planned using MRI. Local recurrences were detected in 8% of all patients operated in group 1 vs 3.5% in group 2 ( P = 0.043). The overall 5‐year survival for all patients in group 1 was 38 vs 62% in group 2 ( P = 0.003). According to multivariate analysis, the new colorectal unit was an independent predictor for improved long‐term survival. Conclusion This population‐based audit shows reduced local recurrence rate and prolonged overall survival for rectal cancer patients after centralization to a single colorectal unit with multidisciplinary management and increased subspecialization.