Management of colorectal cancer: variations in practice in one hospital.
OBJECTIVE
The Royal College of Surgeons of England and the Association of Coloproctology of Great Britain and Ireland guidelines for the management of colorectal cancer were published in 1996. We audited our practice against these guidelines.


METHODS
Data from 211 consecutive patients undergoing colorectal cancer surgery, between September 1999 and September 2000, have been prospectively collected. Preoperative large bowel and liver imaging, assessment by colorectal specialist nurses and median number of lymph nodes resected have been compared between specialist colorectal and non-colorectal surgeons for rectal and colonic cancers. The adequacy of resection and rates of abdomino-perineal resection have been compared for rectal cancers. Following presentation of our findings, we re-audited practice between January and June 2002.


RESULTS
There was marked variation in practice within our hospital. Colorectal specialists were more likely to conform to best practice guidelines, performed fewer abdomino-perineal resections and tended to perform more extensive lymphadenectomy. Following presentation of these data, compliance with guidelines was markedly improved and the number of rectal procedures performed by non-colorectal surgeons decreased.


CONCLUSIONS
The ability of audit to change practice has been demonstrated. We feel that completion of this audit cycle has improved the quality of service we provide for colorectal cancer patients in our hospital.
Duxbury
M S
MS
Colorectal Surgery Unit, Derriford Hospital Plymouth, Devon, UK.
Brodribb
A J
AJ
Oppong
F C
FC
Hosie
K B
KB
D000328:Adult; D000368:Aged; D003082:Colectomy / Q000592:standards / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000592:standards*; D004739:England; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008197:Lymph Node Excision / Q000592:standards / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D016522:Oncology Service, Hospital / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011300:Preoperative Care / Q000592:standards; D011446:Prospective Studies; D013503:Surgery Department, Hospital / Q000592:standards*