title: Violation of treatment guidelines -- hazard for rectal cancer patients.
abstract: OBJECTIVE
  The aim of this study was to evaluate temporal trends in treatment and outcome in rectal cancer diagnosed during 1980-2004 at Levanger Hospital.
  
  
  METHODS
  A protocol for prospective registration of rectal cancer treated with total mesorectal excision including operative strategy, radiotherapy and surveillance was established at Levanger Hospital in 1980. In this study, all rectal cancer patients treated during 1980-2004 were included.
  
  
  RESULTS
  More patients received preoperative radiotherapy during 2000-2004, but otherwise there were no significant differences in presentation or treatment during 1980-2004. The 5-year local recurrence rate after resection with curative intent was 4.5% (0-9.7), 18.7% (10.3-27.1) and 2.2% (0-6.7) in 1980-1989, 1990-1999 and 2000-2004 (p = 0.006), respectively. Out of a total of 23 cases of local recurrence, treatment guidelines, mainly with regard to radiotherapy, were violated in 19 cases. The 5-year overall survival after resection with curative intent was 65% (95% confidence interval [CI] 55-76) during 1980-1989, 58% (49-68) in 1990-1999 and 71% (59-83) in 2000-2004 (n.s). The 5-year relative survival was 83% (95% CI 69-95) during 1980-1989, 71% (59-81) in 1990-1999 and 84% (69-98) in 2000-2004 (n.s).
  
  
  CONCLUSIONS
  Rectal cancer patients experienced excellent outcomes in the period 1980-1989 and 2000-2004. Due to violations of treatment guidelines, the rate of local recurrence was much too high in the period 1990-1999. This article illustrates the importance of continuous quality assurance in the treatment of rectal cancer to maintain optimized outcomes for the patients.
authors.affiliation: Department of Surgery, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
authors.forename: Eivind
authors.initials: E
authors.lastname: Jullumstrø
authors.forename: Arne
authors.initials: A
authors.lastname: Wibe
authors.forename: Stian
authors.initials: S
authors.lastname: Lydersen
authors.forename: Tom-Harald
authors.initials: TH
authors.lastname: Edna
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000532:radiotherapy / Q000601:surgery; D009367:Neoplasm Staging; D009664:Norway / Q000453:epidemiology; D017410:Practice Guidelines as Topic / Q000592:standards*; D012004:Rectal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome