title: Surgery for colorectal cancer in a low-volume unit: assessment of key issues in the achievement of acceptable clinical results.
abstract: BACKGROUND
  The maintenance of modern therapeutic principles requires a proper case load to achieve acceptable surgical results. This may obligate administrative reorganization to overcome these problems and to provide an adequate level of cancer surgery.
  
  
  OBJECTIVE
  To assess the surgical results of patients coming for surgery for colorectal cancer in a low-volume non-academic unit during the past 15 yr.
  
  
  METHODS
  458 consecutive patients referred for surgery between 1988 and 2001 in Kanta-Häme Central Hospital in Finland were analyzed regarding their disease, mode of surgery, and the immediate and long-term result. The data were collected from patient journals and from the National Centre of Statistics and analyzed in two successive periods.
  
  
  RESULTS
  The number of patients with a localized disease (Dukes A + Dukes B) decreased during the followup from 49% to 45%. A curative procedure was achieved in 68% in the first half and in 73% in the second half of the observation period. The immediate mortality was 5% and 2% in the two periods, respectively. The corrected 5-year survival according to the Dukes Classification was 92% (A), 69% (B), 41% (C ), and 6% (D). In curative surgery for rectal cancer, the incidences of local recurrence decreased from 21% to 9% (NS) and the use of permanent colostomy from 59 to 42% (NS).
  
  
  CONCLUSIONS
  Acceptable immediate and long-term results in curative surgery for colorectal cancer can be achieved in a low-volume surgical unit. Nevertheless, owing to the low volume, the improvement of the results obligates team-based institutional specialization and careful consideration about the extensiveness of the primary procedure in case of cancer obstruction.
authors.affiliation: Departments of Surgery, Narvik Hospital, Norway and Jorvi Hospital, Espoo, Finland. hannu.paimela@narvik-sykehus.no
authors.forename: Hannu
authors.initials: H
authors.lastname: Paimela
authors.forename: Outi
authors.initials: O
authors.lastname: Lindström
authors.forename: Timo
authors.initials: T
authors.lastname: Tomminen
authors.forename: Mauri
authors.initials: M
authors.lastname: Iivonen
authors.forename: Esa
authors.initials: E
authors.lastname: Könönen
authors.forename: Pekka
authors.initials: P
authors.lastname: Kuusanmäki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D003125:Colostomy; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011787:Quality of Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome