Standardization of rectal cancer surgery and bowel preparation in Austria : A multicenter nationwide survey by the Austrian Society of Surgical Oncology.
Bowel preparation
Laparoscopic surgery
Learning curve
Rectal cancer
Robotic surgery
Transanal total mesorectal excision
Journal
Wiener klinische Wochenschrift
ISSN: 1613-7671
Titre abrégé: Wien Klin Wochenschr
Pays: Austria
ID NLM: 21620870R
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
19
02
2023
accepted:
14
05
2023
medline:
13
9
2023
pubmed:
26
6
2023
entrez:
26
6
2023
Statut:
ppublish
Résumé
Standardized management of colorectal cancer is crucial for achieving an optimal clinical and oncological outcome. The present nationwide survey was designed to provide data about the surgical management of rectal cancer patients. In addition, we evaluated the standard approach for bowel preparation in all centers in Austria performing elective colorectal surgery. The Austrian Society of Surgical Oncology (ACO["Arbeitsgemeinschaft für chirurgische Onkonlogie"]-ASSO) conducted a multicenter questionnaire-based study comprising 64 hospitals between October 2020 and March 2021. The median number of low anterior resections performed annually per department was 20 (range 0-73). The highest number was found in Vienna, with a median of 27 operations, whereas Vorarlberg was the state with the lowest median number of 13 resections per year. The laparoscopic approach was the standard technique in 46 (72%) departments, followed by the open approach in 30 (47%), transanal total mesorectal excision (TaTME) in 10 (16%) and robotic surgery in 6 hospitals (9%). Out of 64 hospitals 51 (80%) named a standard for bowel preparation before colorectal resections. No preparation was commonly used for the right colon (33%). Considering the low number of low anterior resections performed in each hospital per year in Austria, defined centers for rectal cancer surgery are still scarce. Many hospitals did not transfer recommended bowel preparation guidelines into clinical practice.
Sections du résumé
BACKGROUND
BACKGROUND
Standardized management of colorectal cancer is crucial for achieving an optimal clinical and oncological outcome. The present nationwide survey was designed to provide data about the surgical management of rectal cancer patients. In addition, we evaluated the standard approach for bowel preparation in all centers in Austria performing elective colorectal surgery.
METHODS
METHODS
The Austrian Society of Surgical Oncology (ACO["Arbeitsgemeinschaft für chirurgische Onkonlogie"]-ASSO) conducted a multicenter questionnaire-based study comprising 64 hospitals between October 2020 and March 2021.
RESULTS
RESULTS
The median number of low anterior resections performed annually per department was 20 (range 0-73). The highest number was found in Vienna, with a median of 27 operations, whereas Vorarlberg was the state with the lowest median number of 13 resections per year. The laparoscopic approach was the standard technique in 46 (72%) departments, followed by the open approach in 30 (47%), transanal total mesorectal excision (TaTME) in 10 (16%) and robotic surgery in 6 hospitals (9%). Out of 64 hospitals 51 (80%) named a standard for bowel preparation before colorectal resections. No preparation was commonly used for the right colon (33%).
CONCLUSION
CONCLUSIONS
Considering the low number of low anterior resections performed in each hospital per year in Austria, defined centers for rectal cancer surgery are still scarce. Many hospitals did not transfer recommended bowel preparation guidelines into clinical practice.
Identifiants
pubmed: 37358643
doi: 10.1007/s00508-023-02227-y
pii: 10.1007/s00508-023-02227-y
pmc: PMC10497700
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
457-462Informations de copyright
© 2023. The Author(s).
Références
Wong MCS, Huang J, Lok V, Wang J, Fung F, Ding H, et al. Differences in incidence and mortality trends of colorectal cancer worldwide based on sex, age, and anatomic location. Clinical Gastroenterology and Hepatology. 2021;19(5):955–966.e61.
doi: 10.1016/j.cgh.2020.02.026
pubmed: 32088300
Cardoso R, Guo F, Heisser T, Hackl M, Ihle P, De Schutter H, et al. Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: an international population-based study. Lancet Oncol. 2021;22(7):1002–13.
doi: 10.1016/S1470-2045(21)00199-6
pubmed: 34048685
Ryan OK, Ryan ÉJ, Creavin B, Rausa E, Kelly ME, Petrelli F, et al. Surgical approach for rectal cancer: A network meta-analysis comparing open, laparoscopic, robotic and transanal TME approaches. Eur J Surg Oncol. 2021;47(2):285–95.
doi: 10.1016/j.ejso.2020.06.037
pubmed: 33280950
Detering R, Karthaus EG, Borstlap WAA, Marijnen CAM, van de Velde CJH, Bemelman WA, et al. Treatment and survival of locally recurrent rectal cancer: A cross-sectional population study 15 years after the Dutch TME trial. Eur J Surg Oncol. 2019;45(11):2059–69.
doi: 10.1016/j.ejso.2019.06.016
pubmed: 31230980
Heald RJ, Ryall RDH. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;327(8496):1479–82.
doi: 10.1016/S0140-6736(86)91510-2
van der Pas MHGM, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WCJ, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14(3):210–8.
doi: 10.1016/S1470-2045(13)70016-0
pubmed: 23395398
Martínez-Pérez A, Carra MC, Brunetti F, de’Angelis N. Pathologic outcomes of laparoscopic vs open mesorectal excision for rectal cancer: A systematic review and meta-analysis. JAMA Surgery. 2017;152(4):e165665.
doi: 10.1001/jamasurg.2016.5665
pubmed: 28196217
Son GM, Kim JG, Lee JC, Suh YJ, Cho HM, Lee YS, et al. Multidimensional analysis of the learning curve for laparoscopic rectal cancer surgery. J Laparoendosc Adv Surg Tech A. 2010;20(7):609–17.
doi: 10.1089/lap.2010.0007
pubmed: 20701545
Jiménez-Rodríguez RM, Díaz-Pavón JM, de la Portilla de Juan F, Prendes-Sillero E, Dussort HC, Padillo J. Learning curve for robotic-assisted laparoscopic rectal cancer surgery. Int J Colorectal Dis. 2013;28(6):815–21.
doi: 10.1007/s00384-012-1620-6
pubmed: 23242270
Persiani R, Agnes A, Belia F, D’Ugo D, Biondi A. The learning curve of TaTME for mid-low rectal cancer: a comprehensive analysis from a five-year institutional experience. Surg Endosc. 2021;35(11):6190–200.
doi: 10.1007/s00464-020-08115-0
pubmed: 33106887
Burghgraef TA, Sikkenk DJ, Verheijen PM, Moumni ME, Hompes R, Consten ECJ. The learning curve of laparoscopic, robot-assisted and transanal total mesorectal excisions: a systematic review. Surg Endosc. 2022;36(9):6337–60.
doi: 10.1007/s00464-022-09087-z
pubmed: 35697853
pmcid: 9402498
Güenaga KF, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2011;9:Cd1544.
Cao F, Li J, Li F. Mechanical bowel preparation for elective colorectal surgery: updated systematic review and meta-analysis. Int J Colorectal Dis. 2012;27(6):803–10.
doi: 10.1007/s00384-011-1361-y
pubmed: 22108902
Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280(20):1747–51.
doi: 10.1001/jama.280.20.1747
pubmed: 9842949
Aquina CT, Probst CP, Becerra AZ, Iannuzzi JC, Kelly KN, Hensley BJ, et al. High volume improves outcomes: The argument for centralization of rectal cancer surgery. Surgery. 2016;159(3):736–48.
doi: 10.1016/j.surg.2015.09.021
pubmed: 26576696
Ho V, Heslin MJ, Yun H, Howard L. Trends in hospital and surgeon volume and operative mortality for cancer surgery. Ann Surg Oncol. 2006;13(6):851–8.
doi: 10.1245/ASO.2006.07.021
pubmed: 16614875
Hodgson DC, Zhang W, Zaslavsky AM, Fuchs CS, Wright WE, Ayanian JZ. Relation of hospital volume to colostomy rates and survival for patients with rectal cancer. J Natl Cancer Inst. 2003;95(10):708–16.
doi: 10.1093/jnci/95.10.708
pubmed: 12759388
van Oostendorp SE, Belgers HJ, Bootsma BT, Hol JC, Belt E, Bleeker W, et al. Locoregional recurrences after transanal total mesorectal excision of rectal cancer during implementation. Br J Surg. 2020;107(9):1211–20.
doi: 10.1002/bjs.11525
pubmed: 32246472
Wasmuth HH, Faerden AE, Myklebust T, Pfeffer F, Norderval S, Riis R, et al. Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg. 2020;107(1):121–30.
doi: 10.1002/bjs.11459
pubmed: 31802481
Kaech M, Deutschmann E, Moffa G, Haak F, Bucher HC, Kettelhack C, et al. Influence of the introduction of caseload requirements on indication for visceral cancer surgery in Switzerland. Eur J Surg Oncol. 2021;47(6):1324–31.
doi: 10.1016/j.ejso.2021.04.006
pubmed: 33895025
Devane LA, Proud D, O’Connell PR, Panis Y. A European survey of bowel preparation in colorectal surgery. Colorectal Dis. 2017;19(11):402–06.
doi: 10.1111/codi.13905
Drummond RJ, McKenna RM, Wright DM. Current practice in bowel preparation for colorectal surgery: a survey of the members of the Association of Coloproctology of GB & Ireland. Colorectal Dis. 2011;13(6):708–10.
doi: 10.1111/j.1463-1318.2010.02243.x
pubmed: 20184637
Shahab YK, Ooi K, Berney CR. Evaluating the use of mechanical bowel preparation for elective colorectal resection amongst Australasian surgeons. ANZ J Surg. 2014;84(4):297.
doi: 10.1111/ans.12546
pubmed: 24690356
Businger A, Grunder G, Guenin MO, Ackermann C, Peterli R, von Flüe M. Mechanical bowel preparation and antimicrobial prophylaxis in elective colorectal surgery in Switzerland—a survey. Langenbecks Arch Surg. 2011;396(1):107–13.
doi: 10.1007/s00423-010-0718-y
pubmed: 20972801
Chen M, Song X, Chen LZ, Lin ZD, Zhang XL. Comparing mechanical bowel preparation with both oral and systemic antibiotics versus mechanical bowel preparation and systemic antibiotics alone for the prevention of surgical site infection after elective colorectal surgery: A meta-analysis of randomized controlled clinical trials. Dis Colon Rectum. 2016;59(1):70–8.
doi: 10.1097/DCR.0000000000000524
pubmed: 26651115
Zhang LM, Schuitevoerder D, White MG, Feldt S, Krishnan P, Hyman N, Shogan BD. Combined mechanical and oral antibiotic bowel preparation is associated with prolonged recurrence-free survival following surgery for colorectal cancer. J Surg Oncol. 2021;124(7):1106–14. Dec.
doi: 10.1002/jso.26619
pubmed: 34310702
pmcid: 8610428
Hackl, M. et al. Cancer in Austria, Statistics Austria, 2022, https://www.statistik.at/en/services/tools/services/publikationen/detail/1411 (2022).