Rectal resection following neoadjuvant therapy in a Midwest community hospital setting: The case for standardization over centralization as the means to optimize rectal cancer outcomes in the United States.
Adenocarcinoma of rectum
Neoadjuvant chemoradiotherapy
Neoadjuvant therapy
Outcomes
Rectal cancer resection
Journal
American journal of surgery
ISSN: 1879-1883
Titre abrégé: Am J Surg
Pays: United States
ID NLM: 0370473
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
09
07
2018
revised:
31
08
2018
accepted:
03
09
2018
pubmed:
22
9
2018
medline:
21
11
2019
entrez:
22
9
2018
Statut:
ppublish
Résumé
Incomplete and flawed national databases reveal strikingly inferior outcomes for rectal cancer patients resected at "low" versus "high " volume hospitals, therefore, a study of outcomes of a "high" volume surgeon in a "low" volume Midwest community hospital setting examined this perception in comparison to contemporary studies. Review of 109 consecutive patients who underwent open resection of rectal cancer following neoadjuvant therapy, 1999-2010. Despite the majority of tumors in the low rectum (54%), the rate of abdominoperineal resection was only 39% with R0 resection achieved in 94% and primary anastomosis in 61/109 patients (56%). Disease-free survival (DFS) 73%: stage 0 (complete response)- 100%, stage I- 88%, stage II- 68%, stage III- 50%, stage IV- 0% with recurrence rate of 11% (local recurrence (LR) - 3%, distant - 8%). Outcomes of rectal cancer resection by a "high" volume surgeon in a "low" volume Midwest community hospital setting were comparable to contemporary studies from tertiary care institutions. Geographic location and hospital capacity matter less than access to multispecialty expertise providing neoadjuvant therapy and following standard principles of oncologic resection, in efforts to optimize rectal cancer outcomes.
Sections du résumé
BACKGROUND
Incomplete and flawed national databases reveal strikingly inferior outcomes for rectal cancer patients resected at "low" versus "high " volume hospitals, therefore, a study of outcomes of a "high" volume surgeon in a "low" volume Midwest community hospital setting examined this perception in comparison to contemporary studies.
METHODS
Review of 109 consecutive patients who underwent open resection of rectal cancer following neoadjuvant therapy, 1999-2010.
RESULTS
Despite the majority of tumors in the low rectum (54%), the rate of abdominoperineal resection was only 39% with R0 resection achieved in 94% and primary anastomosis in 61/109 patients (56%). Disease-free survival (DFS) 73%: stage 0 (complete response)- 100%, stage I- 88%, stage II- 68%, stage III- 50%, stage IV- 0% with recurrence rate of 11% (local recurrence (LR) - 3%, distant - 8%).
CONCLUSION
Outcomes of rectal cancer resection by a "high" volume surgeon in a "low" volume Midwest community hospital setting were comparable to contemporary studies from tertiary care institutions. Geographic location and hospital capacity matter less than access to multispecialty expertise providing neoadjuvant therapy and following standard principles of oncologic resection, in efforts to optimize rectal cancer outcomes.
Identifiants
pubmed: 30236488
pii: S0002-9610(18)30979-6
doi: 10.1016/j.amjsurg.2018.09.001
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
430-434Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.