The surgical treatment of rectal cancer in Poland. The findings of a multi-center observational study by the Polish Society of Surgical Oncology (PSSO-01)
, 2, 1, 3, 4, 5, 6, 78, 9, 10, 11, 12, 12, 13, 141516, 1718, 19, 20, 21, 2
Streszczenie
Introduction. PSSO-01, a Polish prospective multi-center project on rectal cancer, started in 2016 with participation on a voluntary basis. This study evaluates the early outcome of the surgical treatment of rectal cancer in Poland according to hospital volume.
Material and methods. The dataset derives from 17 clinical centers registered in the PSSO-01 study. From 2016 to 2020, the data of 1,607 patients were collected. Taking into account the number of patients enrolled in the study, the centers were divided into three categories: high volume, medium volume, and low volume. Nominal variables were compared between different categories of centers using the chi-square test. The STROBE guidelines were used to guarantee the reporting of this observational study.
Results. More patients with metastatic disease were operated on in the low volume centers (p = 0.020). Neoadjuvant treatment was used in 35%, 52%, and 66% of patients operated on in low, medium, and high volume centers respectively (p < 0.001). Laparoscopic resection in medium volume centers was performed more often than in other centers (p < 0.001). The total rate of postoperative complications related to high, medium, and low centers was 22%, 26%, 18% (p = 0.044). One year following surgery, a stoma was present in 63% of patients. A defunctioning stoma following anterior resection was reversed in only 55% of patients. Anastomotic leakage was the main reason for a non-reversal diverting stoma.
Conclusions. The representation of low volume centers in the PSSO-01 study was understated. However, the outcomes may show the actual situation of surgical treatment of rectal cancer in high and medium volume centers in Poland.
Słowa kluczowe: rectal cancersurgeryvolume centerstoma
Referencje
- Błaszkowski T, Celban G, Domagała M, et al. Surgical treatment of rectal cancer in Poland — a report from a prospective, multi-centre observational study PSSO_01 conducted under the auspices of the Polish Society of Surgical Oncology. Nowotwory. Journal of Oncology. 2018; 68(3): 118–126.
- Leersum NJV, Snijders HS, Henneman D, et al. The Dutch Surgical Colorectal Audit. Eur J Surg Oncol. 2013; 39(10): 1063–1070.
- Jegou D, Penninckx F, Vandendael T, et al. PROCARE. Completeness and registration bias in PROCARE, a Belgian multidisciplinary project on cancer of the rectum with participation on a voluntary basis. Eur J Cancer. 2015; 51(9): 1099–1108.
- Majano SB, Girolamo CDi, Rachet B, et al. Surgical treatment and survival from colorectal cancer in Denmark, England, Norway, and Sweden: a population-based study. Lancet Oncol. 2019; 20(1): 74–87.
- Ciesielski P, Berut M, Górnicki K, et al. Assessment of the Surgical Treatment Results in Patients with Colorectal Cancer in a District Hospital Versus Treatment Results in a Highly Specialized Center. Pol Przegl Chir. 2016; 88(4): 188–195.
- Hagemans JAW, Alberda WJ, Verstegen M, et al. Hospital volume and outcome in rectal cancer patients; results of a population-based study in the Netherlands. Eur J Surg Oncol. 2019; 45(4): 613–619.
- Jonker FHW, Hagemans JAW, Burger JWA, et al. Dutch Snapshot Research Group. The influence of hospital volume on long-term oncological outcome after rectal cancer surgery. Int J Colorectal Dis. 2017; 32(12): 1741–1747.
- Leonard D, Penninckx F, Kartheuser A, et al. PROCARE. Effect of hospital volume on quality of care and outcome after rectal cancer surgery. Br J Surg. 2014; 101(11): 1475–1482.
- Schnitzbauer V, Gerken M, Benz S, et al. Laparoscopic and open surgery in rectal cancer patients in Germany: short and long-term results of a large 10-year population-based cohort. Surg Endosc. 2020; 34(3): 1132–1141.
- Snijders HS, van Leersum NJ, Henneman D, et al. Optimal Treatment Strategy in Rectal Cancer Surgery: Should We Be Cowboys or Chickens? Ann Surg Oncol. 2015; 22(11): 3582–3589.
- Gustafsson CP, Gunnarsson U, Dahlstrand U, et al. Loop-ileostomy reversal-patient-related characteristics influencing time to closure. Int J Colorectal Dis. 2018; 33(5): 593–600.
- David GG, Slavin JP, Willmott S, et al. Loop ileostomy following anterior resection: is it really temporary? Colorectal Dis. 2010; 12(5): 428–432.
- Jørgensen JB, Erichsen R, Pedersen BG, et al. Stoma reversal after intended restorative rectal cancer resection in Denmark: nationwide population-based study. BJS Open. 2020 [Epub ahead of print].
- Jutesten H, Draus J, Frey J, et al. High risk of permanent stoma after anastomotic leakage in anterior resection for rectal cancer. Colorectal Dis. 2019; 21(2): 174–182.
- Codd RJ, Evans MD, Davies M, et al. Permanent stoma rates: a misleading marker of quality in rectal cancer surgery. Colorectal Dis. 2014; 16(4): 276–280.
