title: Improved results in rectal cancer surgery-an effect of specialization?
abstract: OBJECTIVE
  The surgeon- and hospital-related variability in outcome after surgery for rectal cancer has been much debated. This study comprises a 6-year period of rectal cancer treatment at a single surgical Institution, where substantial changes in the treatment strategy of rectal cancer were implemented.
  
  
  METHODS
  Prospective and retrospective analysis of complications, stoma frequency, local recurrence rate and survival in 252 patients operated on for rectal cancer before (1990-1992) and after (1994-1996) the creation of a specialized rectal cancer team.
  
  
  RESULTS
  Specialization led to a significant decrease both in the need of permanent stomas (52% before vs 33% after specialization; P=0.02) and in the frequency of local recurrence (18% vs 3%; P=0.002). No increase in the frequency of post-operative complications, re-operations or, specifically, pelvic sepsis could be detected in the later period, although more extensive surgery was used and the anastomotic level decreased from 8 to 4 cm (P < 0.001). Cancer-specific survival at 2 years after operation was significantly higher in patients operated in 1994-1996 than in those operated 1990-1992 (P=0.006).
  
  
  CONCLUSIONS
  Concentrating the care of patients with rectal cancer to a specialized team seems to improve quality and outcome.
authors.affiliation: Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden.
authors.lastname: Machado
authors.lastname: Goldman
authors.lastname: Järhult