title: Multicenter study of outcome in relation to the type of resection in rectal cancer.
abstract: BACKGROUND
  A surgical teaching and auditing program has been implemented to improve the results of treatment for patients with rectal cancer.
  
  
  OBJECTIVE
  The aim of this study was to assess the treatment and outcome in patients resected for rectal cancer, focusing on differences relating to the type of resection.
  
  
  METHODS
  This was an observational study.
  
  
  METHODS
  The study took place throughout the network of hospitals that compose the National Health Service in Spain.
  
  
  METHODS
  This study included a consecutive cohort of 3355 patients from the Spanish Rectal Cancer Project. The data of patients who were operated on electively, with curative intent, by anterior resection (n = 2333 [69.5%]), abdominoperineal excision (n = 774 [23.1%]), and Hartmann procedure (n = 248 [7.4%]) between March 2006 and May 2010 were analyzed.
  
  
  METHODS
  Clinical, pathologic, and outcome results were analyzed in relation to the type of surgery performed.
  
  
  RESULTS
  After a median follow-up time of 37 months (interquartile range, 30-48 months), bowel perforations were found to be more common in the Hartmann procedure (12.6%) and abdominoperineal groups (10.1%) than in the anterior resection group (2.3%; p < 0.001). Involvement of the circumferential resection margin was also more common in the Hartmann (16.6%) and abdominoperineal groups (14.3%) than in the anterior resection group (6.6%; p < 0.001). Multivariate analysis showed a negative influence on local recurrence, metastasis, survival for advanced stage, intraoperative perforation, invaded circumferential margin, and Hartmann procedure. However, abdominoperineal excision did not significantly influence local recurrence (HR, 0.945; 95% CI, 0.571-1.563; p = 0.825).
  
  
  CONCLUSIONS
  The main weakness of this study was the voluntary nature of registration in the Spanish Rectal Cancer Project.
  
  
  CONCLUSIONS
  Although bowel perforation and involvement of the circumferential resection margin were more common after abdominoperineal excision than after anterior resection, this study did not identify abdominoperineal excision as a determinant of local recurrence in the context of 3 years of median follow-up.
authors.affiliation: 1Department of Surgery, Public University of Navarra, Pamplona, Spain 2Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway 3Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway 4Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain 5Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain 6Department of Surgery, Colorectal Unit, Hospital la Fe, Universidad de Valencia, Valencia, Spain 7Department of Surgery, Hospital General Universitario, Valencia, Spain.
authors.forename: Hector
authors.initials: H
authors.lastname: Ortiz
authors.forename: Arne
authors.initials: A
authors.lastname: Wibe
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Ciga
authors.forename: Esther
authors.initials: E
authors.lastname: Kreisler
authors.forename: Eduardo
authors.initials: E
authors.lastname: Garcia-Granero
authors.forename: Jose Vicente
authors.initials: JV
authors.lastname: Roig
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Biondo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D058996:Quality Improvement; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D013030:Spain; D016896:Treatment Outcome