title: The results of total mesorectal excision for rectal carcinoma in a district general hospital before the era of surgical specialization.
abstract: OBJECTIVE: To evaluate the results of rectal cancer surgery performed by a gastrointestinal surgeon in a district general hospital prior to the introduction of specialization, and to compare these to the targets set by the Royal College of Surgeons for specialist units. METHODS: Data collection in 73 consecutive patients (prospective in 53) undergoing elective excisional surgery (sphincter conserving in 77%) for rectal cancer. While adjuvant radio/chemotherapy and pathological assessment evolved over the study period, a standardized surgical technique (total mesorectal excision) was used in all patients. RESULTS: Observed (and recommended) outcome measures were operative mortality 4.1% (<5), anastomotic leak 6.2% (<8), wound infection 2.7% (< 10), pelvic recurrence after curative resection 9.6% (< 10). Temporary defunctioning stomas were used in 32/48 (66.7%) of patients. Other complications, currently without recommended outcomes, were erectile dysfunction (13%), stoma related (7.1%) urinary retention (4.1%), urinary incontinence (2.7%) and benign anastomotic stricture (2.7%). CONCLUSION: All treatment outcome criteria were met. Trained gastrointestinal surgeons outside the setting of a specialist unit can achieve good results with acceptable complication rates.
authors.affiliation: Department of Surgery, Royal Berkshire Hospital, Reading, UK.
authors.forename: S.
authors.initials: S
authors.lastname: Saha
authors.forename: M. I.
authors.initials: MI
authors.lastname: Booth
authors.forename: T. C. B.
authors.initials: TC
authors.lastname: Dehn