Lothian and Borders large bowel cancer project: immediate outcome after surgery. The consultant surgeons and pathologists of the Lothian and Borders Health Boards.

A prospective audit of all large bowel cancer resections is being conducted in the adjacent Health Boards of Lothian and Borders. The results of surgery in 750 consecutive patients recruited during the first 2 years are presented. In this time, 249 (33.2 per cent) patients presented as an emergency, 490 (65.3 per cent) had resection of a colonic cancer, and 36 (4.8 per cent) patients died within 30 days. Abdominal resection was performed in 741 patients and intestinal continuity was restored in 646 (87.2 per cent). Of all anastomoses performed, 31 (4.8 per cent) leaked (15 of 467 (3.2 per cent) and 16 of 179 (8.9 per cent) after resection of colonic and rectal cancers, respectively). Of the patients presenting with a rectal cancer, 251 (96.5 per cent) underwent abdominal resection and intestinal continuity was restored in 179 (71.3 per cent). Five of 28 consultants were responsible for half of these patients. Patients treated by these five consultants were no more likely to undergo anastomosis, but when an anastomosis was performed it was less likely to leak (four of 95 (4.2 per cent) versus 12 of 84 (14.3 per cent) (chi 2 = 4.63, P < 0.05)). The overall outcome of surgery appears to be improved when compared to previous similar audits. Considerable intersurgeon variation remains in the results of resection of rectal cancer.