Colon cancer management and outcome in relation to individual hospitals in a defined population.
BACKGROUND
The Stockholm and Gotland region in Sweden has a common management protocol for the treatment of colon cancer. The aim of this study was to assess the management and treatment of colon cancer in the region and to try to identify ways to improve the outcome further.


METHODS
Clinical data on all patients diagnosed with colon cancer in the region's nine hospitals between January 1996 and December 2000 were prospectively collected. Patients were followed until December 2004, and their management and outcome analysed.


RESULTS
Colon cancer was diagnosed in 2775 patients. An elective operation was performed in 2116 (76.3 per cent) patients and an emergency procedure in 590 (21.3 per cent). Emergency surgery was an independent risk factor for death. The crude overall cumulative 5-year survival was 46.2 per cent. A multivariable analysis of risk of dying and risk of local recurrence showed significant differences between hospitals. The number of lymph nodes examined in the specimens also differed between hospitals.


CONCLUSIONS
Differences in the management and outcome of colon cancer in the nine hospitals, despite a common management protocol, indicate a need for improving collaboration between hospitals and multidisciplinary management.
Sjövall
A
A
Department of Surgery, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden. annika.sjovall@karolinska.se
Holm
T
T
Singnomklao
T
T
Granath
F
F
Glimelius
B
B
Cedermark
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols / Q000592:standards; D003110:Colonic Neoplasms / Q000401:mortality* / Q000601:surgery; D005260:Female; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology