title: Factors affecting morbidity, mortality and survival in patients undergoing surgery for rectal cancer in a district general hospital.
abstract: BACKGROUND
  This is a review of elective rectal cancer surgery during 1993-1999 at a single district general hospital to investigate the variables that affected the care of these patients.
  
  
  METHODS
  A retrospective study of patients presenting with rectal adenocarcinoma to a district general hospital where total mesorectal excision was practiced over a 7-year period was performed to identify factors associated with complications, death and disease recurrence.
  
  
  RESULTS
  Sixty-one patients developed a total of 89 complications and 30-day mortality was 8.3%. Overall, 81% of all resections and 86% of potentially curative resections were free of tumour at the circumferential resection margin. A positive circumferential resection margin and 30-day mortality were both associated with increased postoperative blood transfusion volume. Twenty-nine recurrences were detected during the follow-up period (mean, 21.7 months) and circumferential margin involvement by tumour, Dukes' stage, pre-operative functional status (ASA grade) and length of hospital stay correlated with disease-free survival.
  
  
  CONCLUSIONS
  Surgical outcomes in lower volume hospitals are comparable with those reported by larger centres.
authors.affiliation: Department of Colorectal Surgery, Dewsbury and District Hospital, Dewsbury, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Macadam
authors.forename: Neil
authors.initials: N
authors.lastname: Yeomans
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wilson
authors.forename: William
authors.initials: W
authors.lastname: Case
authors.forename: Clive
authors.initials: C
authors.lastname: White
authors.forename: John
authors.initials: J
authors.lastname: Lovegrove
authors.forename: Philip
authors.initials: P
authors.lastname: Lyndon
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006760:Hospitalization; D006767:Hospitals, District; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality; D010166:Palliative Care; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors