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PROFILE AND EFFECTS OF STUDIES ON QUALITY ASSURANCE IN COLON CANCER CONDUCTED BY A MULTICENTER STUDY GROUP - A REPRESENTATIVE OVERVIEW ON SEQUENTIALLY OBTAINED AND RELEVANT STUDY RESULTS
Frank Meyer*1,2, Steven Krueger1, Henry Ptok1,2, Ralf Steinert3,2, Ronny Otto2, Ingo Gastinger2, Hans Lippert2
1Dept. of General, Abdominal and Vascular Surgery, University Hospital, Magdeburg, Germany; 2Institute of Quality Assurance, Otto-von-Guericke University, Magdeburg, Germany; 3Dept. of General and Abdominal Surgery, St Josefs Hospital, Magdeburg, Germany
Quality management is essential in daily surgical care, in particular, in pursuing optimal diagnostic and therapeutic algorithm.
The aim of this overview is to summarize results obtained in a prospective multicenter observational study on the surgical management of colon cancer and their consequences for daily surgical practice.
Patients & Methods: As substantial part of a prospective multicenter observational study, data on diagnostic, treatment and outcome of patients with colon cancer were documented and analyzed with regard to specific surgical aspects (as subsequently shown) over a defined study period.
Results (selective):
1) Case load in general does not provide necessarily a significant impact onto the outcome.
2) Age can be considered a risk factor, however, it can not be considered a contraindication for surgcial treatment of colon cancer.
3) Hartmann’s procedure is still indicated in high-risk patients and emergency cases (ileus, perforation) to reduce morbidity and mortality.
4) Hospital volume does not provide a significant impact onto the early postoperative outcome. Therefore, there is no need for centralisation of surgical care in colon cancer to tertiary centers since the quality of surgical care is similar at each level of care.
5) Implantation of self-expanding stents (SEMS) can be considered an efficient measure in endoscopic palliation of the malignant colonic stenosis - it reduces postoperative complications in bridging of stenosing tumor growth of colon cancer until surgical intervention.
6) Laparoscopic approach in resection of colon cancer is reasonable in a well defined portion of patients; it should be performed by experienced surgeons since conversion to open surgery is associated with a significant increase of morbidity, mortality and hospital stay.
7) Anastomotic insufficiency in colon resection is a rare but severe complication, which is associated with specific risk factors (such as operation time, ASA score, male sex, ileus, tumor lesion at the left hemicolon, cardiovascular and hepatogenic accompanying diseases, hand suture [one row], occurrence of intraoperative complications, BMI > 30 kg/m2); their knowledge in the perioperative decision-making process is of vital importance in order to sufficiently prevent an increase of morbidity and mortality.
8) The recently suggested German-wide model for quality assessment generates valid and comparable results to other population-based studies; it needs no further specific support to be implemented by the health system in each hospital.
Conclusion: The aquisition of data i) from a representative number of patients, ii) on each level of medical (surgical) care, iii) over an appropriate study period, and iv) to characterize adequately daily surgical practice and its sufficient analysis as well as interpretation can provide important hints and knowledge for future care.
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