Preliminary Results of the First Quality Assurance Project in Rectal Cancer in Poland

• Authors: Paweł Mroczkowski , Stanisław Hać , Michał Mik , Maciej Berut , Łukasz Dziki , Rainer Kube , Zbigniew Śledziński , Hans Lippert , Adam Dziki
• Languages of publication: EN

Abstracts

EN

When compared with other EU countries, Poland is in the last place in terms of efficacy of rectal cancer treatment. In order to remedy this situation, in 2008 Polish centres were given the opportunity to participate in an international programme for evaluating the treatment efficacy.The aim of the study was to present the results obtained during the first two years of research.Material and methods. The study protocol covered 71 questions concerning demographic data, diagnostics, risk factors, peri- and post-operative complications, histopathology, and treatment plan at discharge. The patient and unit data were kept confidential.Results. From 1 January 2008 to 30 December 2009, there were 709 patients recorded, of which 55.9% were males. At least one risk factor was found in approx. 3/4 of patients, while approx. 1/3 of patients were classified to group 3 and 4 according to ASA. The mean distance of the tumour from the anal margin was 8.5 cm; approx. 70% of patients were in the clinical stages cT3 and cT4; metastases were observed in 18.8%. Transrectal endoscopic ultrasonography (TREUS) was performed in 23.7% of patients, magnetic resonance imaging (MRI) in 2.5% and computed tomography (CT) scan - in 48.1%. In close to half of the patients, anterior or low anterior resection of the rectum was performed, and abdominoperineal resection in 1/4 of the patients. Anastomotic leakage was seen in 3.8% of patients, while 1.8% died during hospitalisation.Conclusions. It should be strived after that all the centres undertaking the treatment of rectal cancer should participate in the quality assurance programme. This should enable the achievement of good therapeutic results in patients with rectal cancer treated in Polish centres.

Keywords

EN

rectal cancer; treatment; quality assurance

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2011
• Volume: 83
• Issue: 3
• Pages: 144-149

Dates

published

1 - 3 - 2011

online

2 - 5 - 2011

Contributors

author

Paweł Mroczkowski

• Department of General, Visceral and Vascular Surgery, Otto von Guericke University of Magdeburg, Germany

author

Stanisław Hać

• Department of General, Endocrine and Transplantation Surgery, Medical University in Gdańsk

author

Michał Mik

• Department of General and Colorectal Surgery, Medical University in Łódź

author

Maciej Berut

• Department of General and Colorectal Surgery, Medical University in Łódź

author

Łukasz Dziki

• Department of General and Colorectal Surgery, Medical University in Łódź

author

Rainer Kube

• Department of Surgery, Carl-Thiem-Klinikum, Cottbus, Germany

author

Zbigniew Śledziński

• Department of General, Endocrine and Transplantation Surgery, Medical University in Gdańsk

author

Hans Lippert

• Department of General, Visceral and Vascular Surgery, Otto von Guericke University of Magdeburg, Germany

author

Adam Dziki

• Department of General and Colorectal Surgery, Medical University in Łódź

References

• Berrino F, De AR, Sant M, et al.: Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study. Lancet Oncol 2007 Sep; 8(9): 773-83.[WoS]
• Berrino F, Verdecchia A, Lutz JM, et al.: Comparative cancer survival information in Europe. Eur J Cancer 2009 Apr; 45(6): 901-08.[Crossref][PubMed]
• van Gijn W, Wouters MW, Peeters KC, et al.: Nationwide outcome registrations to improve quality of care in rectal surgery. An initiative of the European Society of Surgical Oncology. J Surg Oncol 2009 Jun 15; 99(8): 491-96.[WoS]
• van Gijn W, van de Velde C: Improving quality of cancer care through surgical audit. Eur J Surg Oncol 2010 Sep; 36 Suppl 1: S23-S26.[Crossref]
• Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med 1997 Apr 3; 336(14): 980-87.
• Bulow S, Harling H, Iversen LH, et al.: Improved survival after rectal cancer in Denmark. Colorectal Dis 2009 Jul 15.[Crossref][WoS]
• Folkesson J, Birgisson H, Pahlman L, et al.: Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 2005 Aug; 20; 23(24): 5644-50.
• Folkesson J, Engholm G, Ehrnrooth E, et al.: Rectal cancer survival in the Nordic countries and Scotland. Int J Cancer 2009 Nov 15; 125(10): 2406-12.[WoS]
• Gondos A, Bray F, Hakulinen T, et al.: Trends in cancer survival in 11 European populations from 1990 to 2009: a model-based analysis. Ann Oncol 2009 Mar; 20(3): 564-73.[WoS]
• Iversen LH, Norgaard M, Jepsen P, et al.: Trends in colorectal cancer survival in northern Denmark: 1985-2004. Colorectal Dis 2007 Mar; 9(3): 210-17.
• Wibe A, Moller B, Norstein J, et al.: A national strategic change in treatment policy for rectal cancer - implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum 2002 Jul; 45(7): 857-66.[Crossref]
• Wibe A, Carlsen E, Dahl O, et al.: Nationwide quality assurance of rectal cancer treatment. Colorectal Dis 2006 Mar; 8(3): 224-29.[Crossref][PubMed]
• Mroczkowski P, Kube R, Schmidt U, et al.: Quality Assessment of Colorectal Cancer Care - an International Online Model. Colorectal Dis 2010 May 17.[WoS]
• Krajowa Baza Danych Nowotworowych. Available from:
• Nationanellt kvalitetsregister Cancer rekti 2008. Umea: 2009.
• Beets-Tan RG, Beets GL, Vliegen RF, et al.: Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet 2001 Feb 17; 357(9255): 497-504.
• Brown G, Richards CJ, Newcombe RG, et al.: Rectal carcinoma: thin-section MR imaging for staging in 28 patients. Radiology 1999 Apr; 211(1): 215-22.
• Smith N, Brown G: Preoperative staging of rectal cancer. Acta Oncol 2008; 47(1): 20-31.[Crossref][PubMed]
• Lahaye MJ, Engelen SM, Nelemans PJ, et al.: Imaging for predicting the risk factors - the circumferential resection margin and nodal disease - of local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR 2005 Aug; 26(4): 259-68.
• Extramural depth of tumor invasion at thinsection MR in patients with rectal cancer: results of the MERCURY study. Radiology 2007 Apr; 243(1): 132-39.[WoS]
• Pahlman L, Bohe M, Cedermark B, et al.: The Swedish rectal cancer registry. Br J Surg 2007 Oct; 94(10): 1285-92.
• Peeters KC, Marijnen CA, Nagtegaal ID, et al.: The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 2007 Nov; 246(5): 693-701.[WoS]
• Sebag-Montefiore D, Stephens RJ, Steele R, et al.: Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 2009 Mar 7; 373(9666): 811-20.[WoS]
• Junginger T, Kneist W, Heintz A: Influence of identification and preservation of pelvic autonomic nerves in rectal cancer surgery on bladder dysfunction after total mesorectal excision. Dis Colon Rectum 2003 May; 46(5): 621-28.[Crossref][PubMed]
• Kneist W, Heintz A, Junginger T: Intraoperative identification and neurophysiologic parameters to verify pelvic autonomic nerve function during total mesorectal excision for rectal cancer. J Am Coll Surg 2004 Jan; 198(1): 59-66.
• Kneist W, Heintz A, Wolf HK, et al.: Identification of pelvic autonomic nerves during partial and total mesorectal excision - influence parameters and significance for neurogenic bladder. Chirurg 2004 Mar; 75(3): 276-83.
• Kneist W, Heintz A, Junginger T: Major urinary dysfunction after mesorectal excision for rectal carcinoma. Br J Surg 2005 Feb; 92(2): 230-34.[Crossref]
• Bertelsen CA, Andreasen AH, Jorgensen T, et al.: Anastomotic leakage after anterior resection for rectal cancer: risk factors. Colorectal Dis 2010 Jan; 12(1): 37-43.[PubMed][Crossref]
• Rozen P, Blanchard J, Campbell D, et al.: Implementing Colorectal Cancer Screening: Group 2 Report. ESGE/UEGF Colorectal Cancer - Public Awareness Campaign. The Public/Professional Interface Workshop: Oslo, Norway, June 20 - 22, 2003. Endoscopy 2004 Apr; 36(4): 354-58.
• Regula J, Rupinski M, Kraszewska E, et al.: Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 2006 Nov 2; 355(18): 1863-72.
• Williams GT, Quirke P, Shepherd NA: The Royal College of Pathologists: Standards and Datasets for Reporting Cancers: Dataset for colorectal cancer (2nd edition). 2010 Available from:
• Maughan NJ, Morris E, Forman D, et al.: The validity of the Royal College of Pathologists' colorectal cancer minimum dataset within a population. Br J Cancer 2007 Nov 19; 97(10): 1393-98.[Crossref]
• Nickelsen TN, Jorgensen T, Kronborg O: Thirty-day mortality after surgery for colorectal cancer in Denmark. Colorectal Dis 2005 Sep; 7(5): 500-06.[PubMed][Crossref]
• Bittner R, Burghardt J, Gross E, et al.: [Quality indicators for diagnostic and therapy of rectal carcinoma]. Zentralbl Chir 2007 Apr; 132(2): 85-94.

Identifiers

DOI

10.2478/v10035-011-0022-8