title: Quality management in rectal carcinoma: what is feasible?
abstract: OBJECTIVE
  A cohort study was carried out to analyse quality indicators in the diagnosis and treatment of rectal carcinoma.
  
  
  METHODS
  A total of 2,470 patients with rectal carcinoma treated between 1985 and 2007 at the Department of Surgery, University of Erlangen, were analysed and compared within four time intervals.
  
  
  RESULTS
  Most of the indicators analysed from 2004 to 2007 fulfilled the defined target values. The indicators for process quality of surgical treatment and the surrogate indicators of outcome quality in surgery showed excellent results. Comparing this to previous data, it displays the new developments such as introduction of multimodal treatment for high-risk patients. While the rate of locoregional recurrences decreased, no significant improvement in survival was found.
  
  
  CONCLUSIONS
  Careful analysis of quality indicators is important for both quality management and comparison of treatment results. The progress in diagnosis and treatment requires a continuous update of definitions and target values.
authors.affiliation: Department of Surgery, University Hospital Erlangen, Erlangen, Germany. susanne.merkel@uk-erlangen.de
authors.forename: Susanne
authors.initials: S
authors.lastname: Merkel
authors.forename: Daniela
authors.initials: D
authors.lastname: Klossek
authors.forename: Jonas
authors.initials: J
authors.lastname: Göhl
authors.forename: Thomas
authors.initials: T
authors.lastname: Papadopoulos
authors.forename: Werner
authors.initials: W
authors.lastname: Hohenberger
authors.forename: Paul
authors.initials: P
authors.lastname: Hermanek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000592:standards; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000592:standards; D009364:Neoplasm Recurrence, Local; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000592:standards*; D018714:Radiotherapy, Adjuvant / Q000592:standards; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D012042:Registries; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult