OBJECTIVE: The surgeon- and hospital-related variability in outcome after surgery for rectal cancer has been much debated. This study comprises a 6-year period of rectal cancer treatment at a single surgical Institution, where substantial changes in the treatment strategy of rectal cancer were implemented. PATIENTS AND METHODS: Prospective and retrospective analysis of complications, stoma frequency, local recurrence rate and survival in 252 patients operated on for rectal cancer before (1990-1992) and after (1994-1996) the creation of a specialized rectal cancer team. RESULTS: Specialization led to a significant decrease both in the need of permanent stomas (52% before vs 33% after specialization; P=0.02) and in the frequency of local recurrence (18% vs 3%; P=0.002). No increase in the frequency of post-operative complications, re-operations or, specifically, pelvic sepsis could be detected in the later period, although more extensive surgery was used and the anastomotic level decreased from 8 to 4 cm (P < 0.001). Cancer-specific survival at 2 years after operation was significantly higher in patients operated in 1994-1996 than in those operated 1990-1992 (P=0.006). CONCLUSION: Concentrating the care of patients with rectal cancer to a specialized team seems to improve quality and outcome.
OBJECTIVE: The surgeon- and hospital-related variability in outcome after surgery for rectal cancer has been much debated. This study comprises a 6-year period of rectal cancer treatment at a single surgical Institution, where substantial changes in the treatment strategy of rectal cancer were implemented. PATIENTS AND METHODS: Prospective and retrospective analysis of complications, stoma frequency, local recurrence rate and survival in 252 patients operated on for rectal cancer before (1990-1992) and after (1994-1996) the creation of a specialized rectal cancer team. RESULTS: Specialization led to a significant decrease both in the need of permanent stomas (52% before vs 33% after specialization; P=0.02) and in the frequency of local recurrence (18% vs 3%; P=0.002). No increase in the frequency of post-operative complications, re-operations or, specifically, pelvic sepsis could be detected in the later period, although more extensive surgery was used and the anastomotic level decreased from 8 to 4 cm (P < 0.001). Cancer-specific survival at 2 years after operation was significantly higher in patients operated in 1994-1996 than in those operated 1990-1992 (P=0.006). CONCLUSION: Concentrating the care of patients with rectal cancer to a specialized team seems to improve quality and outcome.