Quality assurance in rectal cancer treatment in the Netherlands: a catch up compared to colon cancer treatment.
BACKGROUND
In the Netherlands, the Total Mesorectal Excision (TME) surgical technique for rectal cancer was introduced together with pre-operative radiotherapy in a quality controlled manner within the framework of the TME trial (1996-1999). The aim of this study is to examine the effects of the structural changes in rectal cancer care on survival compared to colon cancer for patients treated before, during and after the TME trial.


METHODS
We compared overall survival of all patients with curatively resected colon (n = 15,266) and rectal cancer (n = 5839) in the regions of Comprehensive Cancer Centres South and West between 1990 and 2005, adjusting for prognostic variables.


RESULTS
In the pre-trial period, rectal cancer had a significant lower survival compared to colon cancer (HR 1.248, P < 0.01). However, in the post-trial period, survival after rectal cancer was similar to colon cancer (HR 0.987, n.s.).


CONCLUSIONS
Although survival improved significantly for both colon and rectal cancer in the last 15 years, the substantially worse results after rectal cancer have been eliminated. This study shows the lasting effects that structural surgical training and quality assurance can have on survival outcome.
van Gijn
W
W
Department of Surgery, Leiden University Medical Center, K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Krijnen
P
P
Lemmens
V E P P
VE
den Dulk
M
M
Putter
H
H
van de Velde
C J H
CJ
D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002986:Clinical Trials as Topic; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D011785:Quality Assurance, Health Care; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D012042:Registries; D015996:Survival Rate; D016896:Treatment Outcome