title: Management of rectal cancers in relation to treatment guidelines: a population-based study comparing Italian and French patients.
abstract: BACKGROUND
  Few studies have investigated rectal cancer management at the population level. We compared how rectal cancers diagnosed in Italy (2003-2005) and France (2005) were managed, and evaluated the extent to which management adhered to European guidelines.
  
  
  METHODS
  Samples of 3938 Italian and 2287 French colorectal cancer patients were randomly extracted from 8 and 12 cancer registries respectively. Rectal cancer patients (860 Italian, 559 French) were analysed. Logistic regression models estimated odds ratios (ORs) of being treated with curative intent, receiving sphincter-saving surgery, and receiving preoperative radiotherapy.
  
  
  RESULTS
  Similar proportions of Italian and French patients were treated with curative intent (70% vs. 67%; OR=0.92 [0.73-1.16]); the respective proportions receiving sphincter-saving surgery were 21% and 33% (OR=1.15 [0.86-1.53]). In about 50% of those treated with curative intent, ≥ 12 lymph nodes were harvested in both countries. The proportion receiving postoperative radiotherapy was higher in Italy than in France (25% vs. 11%, p<0.01), but French patients were more likely to receive preoperative radiotherapy (52% vs. 21%; OR=4.06 [2.79-5.91]).
  
  
  CONCLUSIONS
  The proportions of patients receiving preoperative radiotherapy and the numbers of lymph nodes sampled were low in both countries. Centralising treatment and potentiating screening would be practical ways of improving outcomes and adhering to guidelines.
authors.affiliation: Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: pamela.minicozzi@istitutotumori.mi.it.
authors.forename: Pamela
authors.initials: P
authors.lastname: Minicozzi
authors.affiliation: Digestive Cancers Registry of Burgundy, University Hospital Dijon, Inserm U866, University of Burgundy, Dijon, France; FRANCIM (French Network of Cancer Registries), France.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Bouvier
authors.affiliation: Digestive Cancers Registry of Burgundy, University Hospital Dijon, Inserm U866, University of Burgundy, Dijon, France; FRANCIM (French Network of Cancer Registries), France.
authors.forename: Jean
authors.initials: J
authors.lastname: Faivre
authors.affiliation: Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Sant
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D005260:Female; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008197:Lymph Node Excision / Q000592:standards*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000592:standards; D059351:Organ Sparing Treatments / Q000592:standards*; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant / Q000592:standards*; D012004:Rectal Neoplasms / Q000628:therapy*
keywords: Cancer registry; Management; Rectal cancer