Surgical quality in rectal cancer management: What can be achieved by a voluntary observational study?

Abstract

Purpose. Countries with nationwide quality programmes in colorectal cancer report an improved outcome. In Germany, a self-organized and self-financed observational quality assurance project exists, based on voluntary participation. The object of the present study was to ascertain whether this nationwide project also improves the outcome of colorectal cancer. Methods. The German Quality Assurance in Colorectal Cancer Project started in 2000 and by 2012 contained 85,000 patients. Inclusion criteria for the study were participation for the entire period of 13 years and treatment of rectal cancer. The following parameters were analysed: (1) patient related: age, gender, ASA classification, T-stage, and N-stage, (2) system related: frequency of preoperative CT and MRI, and (3) outcome related: CRM status, complications, and hospital mortality. Results. Forty-one of the 345 hospitals treating 11,597 patients fulfilled the inclusion criteria. The median age increased from 67 to 69 years (p=0.002). ASA stages III and IV increased from 32.0% to 37.6% (p=0.005) and from 2.0% to 3.3% (p=0.022), respectively. The use of CT rose from 67.2% to 88.8% (p<0.001) and that of MRI from 5.0% to 35.2% (p<0.001). The proportion of patients suffering from complications decreased from 7.9% to 5.3% (p<0.001) for intraoperative and from 28.0% to 18.6% (p<0.001) for postoperative surgical complications, but general postoperative complications increased from 25.8% to 29.5% (p=0.006). The distribution of histopathological stage, anastomotic leakage, and in-hospital mortality did not change significantly. Conclusion. Participation in a quality assurance project improves compliance with treatment standards, especially for diagnostic procedures. An improvement of surgical results will require further investment in training.