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Time trends, improvements and national auditing of rectal cancer management over an 18-year period
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
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2015 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 17, no 9, O168-O179 p.Article in journal (Refereed) Published
Abstract [en]

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 29925 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 90days 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.

Place, publisher, year, edition, pages
2015. Vol. 17, no 9, O168-O179 p.
Keyword [en]
Rectal neoplasms, registries, quality control, therapy, surgery
National Category
Cancer and Oncology Surgery
URN: urn:nbn:se:uu:diva-261935DOI: 10.1111/codi.13060ISI: 000359351000002PubMedID: 26155848OAI: oai:DiVA.org:uu-261935DiVA: diva2:855831
Swedish Cancer SocietySwedish Association of Local Authorities and Regions
Available from: 2015-09-22 Created: 2015-09-07 Last updated: 2015-09-22Bibliographically approved

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Birgisson, HelgiGlimelius, BengtPåhlman, Lars
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