[Rectal cancer treated at a county hospital. A prospective study of an 11-year period].
BACKGROUND
The results of rectal cancer surgery in a county hospital during an 11-year period from 1991 to 2002 are presented. Complications, local recurrence rate and survival were registered.


METHODS
One hundred patients operated by one surgeon were included in the study. Twelve were Dukes' type A, 36 B, 48 C, and four were D. Low anterior resection was performed in 68 patients (six with J-pouch), abdominoperineal resection in 29 and a Hartmann's procedure in three patients. The operation was radical in 80 patients. Until December 31, 1994 a conventional operation was performed in 34 patients. Thereafter total mesorectal excision was introduced with excision of the mesorectum for tumours below 10 cm from the anal verge and resection of the mesorectum 5 cm below tumour for higher tumours (46 patients).


RESULTS
Thirty days mortality was 4%. The clinical leakage rate after resection was 10% and 6% ended up with a permanent stoma. There were no deaths among patients with leakage. As a consequence of the change in surgical technique from January 1, 1995 the 5-year local recurrence rate declined from 0.32 to 0.11 (p = 0.13) and the overall survival rate exhibited a slightly rising tendency from 0.62 to 0.70 (p = 0.47).


CONCLUSIONS
Operations for rectal cancer can be performed in a county hospital with a satisfactory outcome as to complication rates and operative mortality provided the operations are concentrated on few hands. The local recurrence rate and the overall survival showed non-significant tendencies to improvement with the introduction of a more radical operation which is in accordance with results from international trials.
Kiil
Jørgen
J
Viborg Sygehus, Organkirurgisk Afdeling. joergenkiil@dadlnet.dk
D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003718:Denmark; D005260:Female; D006766:Hospitals, County / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome