title: Retrospective review of rectal cancer surgery in northern Alberta.
abstract: BACKGROUND
  Previous studies, including research published more than 10 years ago in Northern Alberta, have demonstrated improved outcomes with increased surgical volume and subspecialisation in the treatment of rectal cancer. We sought to examine contemporary rectal cancer care in the same region to determine whether practice patterns have changed and whether outcomes have improved.
  
  
  METHODS
  We reviewed the charts of all patients with rectal adenocarcinoma diagnosed between 1998 and 2003 who had a potentially curative resection. The main outcomes examined were 5-year local recurrence (LR) and disease-specific survival (DSS). Surgeons were classified into 3 groups according to training and volume, and we compared outcome measures among them. We also compared our results to those of the previous study from our region.
  
  
  RESULTS
  We included 433 cases in the study. Subspecialty-trained colorectal surgeons performed 35% of all surgeries in our study compared to 16% in the previous study. The overall 5-year LR rate and DSS in our study were improved compared to the previous study. On multivariate analysis, the only factor associated with increased 5-year LR was presence of obstruction, and the factors associated with decreased 5-year DSS were high-volume noncolorectal surgeons, presence of obstruction and increased stage.
  
  
  CONCLUSIONS
  Over the past 10 years, the long-term outcomes of treatment for rectal cancer have improved. We found that surgical subspecialization was associated with improved DSS but not LR. Increased surgical volume was not associated with LR or DSS.
authors.affiliation: Department of Surgery, University of Alberta, Edmonton, Alta. pelletie@ualberta.ca
authors.forename: Jean-Sébastien
authors.initials: JS
authors.lastname: Pelletier
authors.forename: Christopher
authors.initials: C
authors.lastname: Degara
authors.forename: Geoff
authors.initials: G
authors.lastname: Porter
authors.forename: Sunita
authors.initials: S
authors.lastname: Ghosh
authors.forename: Dan
authors.initials: D
authors.lastname: Schiller
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D001003:Anal Canal; D003107:Colorectal Surgery / Q000193:education / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013043:Specialties, Surgical