title: Centralization of rectal cancer surgery improves long-term survival.
abstract: OBJECTIVE
  In 1996, rectal cancer surgery in the Swedish county of Vstmanland was centralized to a single colorectal unit. At the same time, total mesorectal excision and multidisciplinary team meetings were introduced. The aim of this audit was to determine the long-term results before and after centralization.
  
  
  METHODS
  All consecutive rectal cancer patients who underwent curative or palliative surgery at one of the county's four hospitals between 1993 and 1996 (n = 133, group 1) were compared with patients operated at the new centralized colorectal unit between 1996 and 1999 (n = 144, group 2).
  
  
  RESULTS
  Preoperative radiotherapy was common in both groups, but in group 2, it was planned using MRI. Local recurrences were detected in 8% of all patients operated in group 1 vs 3.5% in group 2 (P = 0.043). The overall 5-year survival for all patients in group 1 was 38 vs 62% in group 2 (P = 0.003). According to multivariate analysis, the new colorectal unit was an independent predictor for improved long-term survival.
  
  
  CONCLUSIONS
  This population-based audit shows reduced local recurrence rate and prolonged overall survival for rectal cancer patients after centralization to a single colorectal unit with multidisciplinary management and increased subspecialization.
authors.affiliation: Colorectal Unit, Department of Surgery and Centre for Clinical Research of Uppsala University, Central Hospital, Västerås, Sweden. maziar.hosseinalikhani@ltv.se
authors.forename: M Hosseinali
authors.initials: MH
authors.lastname: Khani
authors.forename: K
authors.initials: K
authors.lastname: Smedh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002497:Centralized Hospital Services; D013505:Digestive System Surgical Procedures; D005260:Female; D006766:Hospitals, County; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D012017:Referral and Consultation; D012189:Retrospective Studies; D013548:Sweden