[Quality standards in rectal cancer surgery].
The results of surgery for rectal cancer have classically been measured through indicators such as morbidity, mortality, and length of hospital stay. In the last few years other parameters have been included that evaluate healthcare quality such as the functional results of the surgical technique employed and quality of life. Total resection of the mesorectum, performed by experienced surgeons, is the surgical technique of choice. Currently, the sphincter can be preserved in 70% of patients. Anastomotic dehiscence after anterior resection of the rectum is the most serious complication and the most important risk factor is the height of the anastomosis. The overall dehiscence rate should be less than 15% and operative mortality should be between 2% and 3%. The colonic reservoir improves functional outcome and consequently it is the procedure of choice to reconstruct transit after low anterior resection. Local recurrence should be less than 10% and 5-year survival should be between 70% and 80%. In general, quality of life is better after anterior resection of the rectum than after abdominoperineal amputation, despite the functional deterioration presented by some patients.
Pera
M
M
Unidad de Cirugía Colorrectal, Servicio de Cirugía General, Hospital del Mar, Barcelona, España. mpera@imas.imim.es
Pascual
M
M
D000671:Amputation, Surgical; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D017024:Chemotherapy, Adjuvant; D039021:Colonic Pouches; D003107:Colorectal Surgery; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000401:mortality / Q000523:psychology / Q000592:standards*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000523:psychology / Q000532:radiotherapy / Q000601:surgery*; D012307:Risk Factors; D013529:Surgical Wound Dehiscence; D015996:Survival Rate; D016896:Treatment Outcome