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PROFILE AND VALUE OF STUDIES ON QUALITY ASSURANCE IN RECTAL CANCER CONDUCTED BY A MULTICENTER STUDY GROUP AND A REPRESENTATIVE OVERVIEW ON THE SYSTEMATICALLY OBTAINED AND MOST RELEVANT STUDY RESULTS
Frank Meyer*1,2, Tobias Goldbach1, 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 at Magdeburg, Magdeburg, Germany; 3Dept. of General and Abdominal Surgery, St Josefs Hospital, Salzkotten, Germany
Continuous analyses of surgical quality as substantial part of clinical research are essential to establish optimal diagnostic and therapeutic algorithms.
The aim of this overview is to demonstrate data, which were systematically obtained by multicenter observational studies, and findings, which were successively derived for clinical practice in the management of rectal cancer.
Patients & Methods: Over a defined study period, patient-, treatment- and tumor-associated data on surgical patients with rectal cancer who had been enrolled in a prospective multicenter observational study (design) were documented and analyzed with regard to various aspects as subsequently shown.
Results:
Hospital volume did not have a significant impact onto the oncosurgical long-term outcome but showed an inverse correlation to the frequency of creation of a permanent stoma and postoperative morbidity.
Neoadjuvant radiochemotherapy did not increase the risk of a postoperative anastomotic insufficiency or dysfunction of the urinary bladder after sphincter-preserving rectal resection with curative intention.
Specific study results on the diagnostic accuracy of endorectal ultrasonography (EUS) to assess T-category could not be confirmed in daily surgical practice.
Creation of a protective enterostoma did not reduce the frequency of a postoperative anastomotic insufficiency but it lowered the frequency of following surgical or interventional consequences.
Quality of Total Mesorectal Exzision (TME) depends on patient- (such as patient’s age, tumor site, pT-category) and treatment-associated factors (such as technique of surgical dissection, surgeon’s case load).
Patient’s age is a risk factor but it can not be considered a general contraindication for resection of rectal cancer.
Oncological outcome after laparoscopic rectum resection is comparable with that after open resection. However, necessity for conversion can worsen long-term oncosurgical outcome.
Limited resection of pT1-low-risk carcinoma may provide an acceptable oncosurgcial outcome but needs to be considered a compromise to radical resection.
Rate of abdominoperineal rectum exstirpation (APR) has been reduced in routine surgical care down to approximately 20% over the last years.
Isolated invasion of lymphatic vessels could not be identified as independent risk factor for local or systemic tumor recurrence and, in addition, did not show an impact onto long-term survival after radical resection.
Disturbances of wound healing after APR can be reduced down to 5% by using antibiotic-releasing collagen-based biomaterial constructs in addition to the well-established wound closure of each single layer.
Conclusion: The results i) reflect real situation in abdominal surgery in Germany, ii) have influenced disease-specific clincial management, and iii) may define novel subjects of up-coming studies.
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