Colorectal cancer management in the provincial New Zealand setting of Nelson.
BACKGROUND
Colorectal cancer surgery, and rectal surgery in particular, has benefited from increased regionalization and subspecialization. With increasing focus on dedicated colorectal units in tertiary centres, the role of smaller provincial hospitals in colorectal cancer surgery has been of topical interest. Little data of relevance to this issue are available from provincial centres in New Zealand. The present study determines the workload and outcomes of a general surgeon with a colorectal subspecialty interest operating in the provincial New Zealand setting of Nelson.


METHODS
A retrospective review of consecutive case notes was conducted for the period January 2000 to December 2004, including all colorectal cancer patients managed by the relevant surgeon. The complete management pathway was evaluated.


RESULTS
One hundred and fifty colorectal cancers were managed; 133 operations were conducted, including 41 anterior resections and 13 abdominoperineal (AP) resections. Of these operations, 91% were scheduled and 9% were emergencies. The postoperative mortality rate was 0.8% and unplanned return-to-theatre rate 3.1%. Anastomotic leak occurred in 4.6%, all after anterior resection (anterior resection rate: 12.2%). Two were 'major' leaks, requiring return to theatre. The local recurrence rate following anterior resection was 7.3% at a median follow-up duration of 31 months.


CONCLUSIONS
Incidence is such that high-volume colorectal surgery is possible even in a smaller New Zealand province. Surgical practice and outcomes withstood comparison to published results - a broad general surgical case mix and low-volume hospital environment were not significant barriers to quality of colorectal care. Provincial colorectal cancer management remains an important resource for patients living outside major New Zealand centres.
O'Grady
Gregory
G
Department of General Surgery, Nelson Hospital, Nelson, New Zealand. gog@ps.gen.nz
Secker
Adrian
A
D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D003107:Colorectal Surgery / Q000592:standards; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009364:Neoplasm Recurrence, Local; D009520:New Zealand / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data