title: [Self-evaluation of a clinical pathway to improve the results of rectal cancer].
abstract: OBJECTIVE
  To analyse whether the self-evaluation of a clinical pathway improves the results of rectal cancer (RC) treatment.
  
  
  METHODS
  Patients operated on for RC were divided into 3 groups according to biannual modifications of a clinical pathway analysing several indicators.
  
  
  RESULTS
  166 patients: Group A: 2002-3 n=50, B: 2004-5 n=53 and C: 2006-7 n=63, without any differences in age, gender or comorbidity. Preoperative study improved with the introduction of CT scan: 76% in Group C vs. 6% in Group A (P<0.001). All Group C tumours were staged using MR, rectal ultrasound or both, compared to 84% in Group A (P<0.001). The rate of abdominal-perineal resections was reduced from 42% (Group A) to 17% (Group C); (P=0.007) and about 48% of surgeons in Group A vs. 94% in the C had a specific activity in coloproctology (P<0.001). The average lymph node count was: Group A=6.2+/-4.5 vs. 13+/-6.5 in the C and circumferential margin analysis was reported in 24% of Group A vs. 76% in Group C (P<0.001). Parameters such as perioperative blood transfusion, ICU admission, use of nasogastric tube, early feeding or epidural analgesia also improved progressively. Operative mortality decreased non-significantly to 4.7% and anastomotic leaks from 24% to 9.5% with a reduction in postoperative stay from 15 to 11 days during the period analysed (P=0.029).
  
  
  CONCLUSIONS
  Several indicators have significantly improved in a relatively short period of time due to self-evaluations of the process.
authors.affiliation: Servicio de Cirugía General y Digestiva, Consorcio Hospital General Universitario de Valencia, Valencia, España. crisanmo10@hotmail.com
authors.forename: Cristina
authors.initials: C
authors.lastname: Sancho
authors.forename: Francisco L
authors.initials: FL
authors.lastname: Villalba
authors.forename: M José
authors.initials: MJ
authors.lastname: García-Coret
authors.forename: Antonio
authors.initials: A
authors.lastname: Vázquez
authors.forename: M José
authors.initials: MJ
authors.lastname: Safont
authors.forename: Ana
authors.initials: A
authors.lastname: Hernández
authors.forename: Encarnación
authors.initials: E
authors.lastname: Martínez
authors.forename: Vicente
authors.initials: V
authors.lastname: Martínez-Sanjuán
authors.forename: Juan
authors.initials: J
authors.lastname: García-Armengol
authors.forename: José V
authors.initials: JV
authors.lastname: Roig
mesh_terms: D000368:Aged; D001294:Attitude to Health; D005260:Female; D006801:Humans; D008297:Male; D012004:Rectal Neoplasms / Q000601:surgery*; D012649:Self Concept; D016896:Treatment Outcome