title: Improved quality of care for patients undergoing an abdominoperineal excision for rectal cancer.
abstract: BACKGROUND
  New diagnostics, the emergence of total mesorectal excision and neoadjuvant treatments have improved outcome for patients with rectal cancer. Patients with distal rectal cancer undergoing an abdominoperineal excision seem to do worse compared to those treated with sphinctersparing techniques. The aim of this study was to evaluate the quality of care for patients undergoing an abdominoperineal excision for distal rectal cancer during the last 15 years.
  
  
  METHODS
  All patients with rectal cancer, who underwent an abdominoperineal excision between December 1996 and December 2010 in 5 Dutch hospitals were analysed. Patients were divided into three cohorts; 1996-2001, 2001-2005 and 2006-2010. All data was extracted from medical records.
  
  
  RESULTS
  477 patients were identified. There was no significant difference in sex, age, BMI, prior pelvic surgery and ASA stages between the cohorts. MRI became a standard tool in the work-up, the use increased from 4.5% in the first, to 95.1% in the last cohort (p < 0.0001). Neoadjuvant treatment shifted from predominantly none (64.9% in cohort 1) to short course radiotherapy (66.7% in cohort 2) and chemoradiation therapy (55.7% in cohort 3). There was a trend towards a decreased circumferential resection margin involvement in the cohorts (18.8%, 16.7% and 11.4%; p = 0.142). Accidental bowel perforations have significantly decreased from 28.6%, and 21.7% to 9.2% in cohort 3 (p < 0.0001).
  
  
  CONCLUSIONS
  Significant improvements in work-up, neoadjuvant and surgical treatment have been made for patients with low rectal cancer, undergoing an abdominoperineal excision. These improvements result in improved short term outcome.
authors.affiliation: Radboud University Nijmegen Medical Centre, Department of Surgery, Postbus 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: guus.bokkerink@radboudumc.nl.
authors.forename: G M J
authors.initials: GM
authors.lastname: Bökkerink
authors.affiliation: Radboud University Nijmegen Medical Centre, Department of Surgery, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: E F M
authors.initials: EF
authors.lastname: Buijs
authors.affiliation: Elisabeth Hospital, Department of Surgery, Postbus 30151, 5000 LC Tilburg, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: de Ruijter
authors.affiliation: Canisius Wilhelmina Hospital, Department of Surgery, Postbus 9015, 6500 GS, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Rosman
authors.affiliation: Gelderse Vallei Hospital, Department of Surgery, Postbus 9025, 6710 HN Ede, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Sietses
authors.affiliation: Bernhoven Hospital, Department of Surgery, Postbus 707, 5400 AS Uden, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Strobel
authors.affiliation: Elisabeth Hospital, Department of Surgery, Postbus 30151, 5000 LC Tilburg, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Heisterkamp
authors.affiliation: Radboud University Nijmegen Medical Centre, Department of Pathology, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: I D
authors.initials: ID
authors.lastname: Nagtegaal
authors.affiliation: Radboud University Nijmegen Medical Centre, Department of Surgery, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: A J A
authors.initials: AJ
authors.lastname: Bremers
authors.affiliation: Radboud University Nijmegen Medical Centre, Department of Surgery, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: J H W
authors.initials: JH
authors.lastname: de Wilt
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000628:therapy*; D000368:Aged; D059186:Chemoradiotherapy, Adjuvant / Q000639:trends; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000592:standards / Q000639:trends*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D007902:Length of Stay; D008279:Magnetic Resonance Imaging / Q000639:trends; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000639:trends; D009426:Netherlands; D058996:Quality Improvement / Q000639:trends*; D018714:Radiotherapy, Adjuvant / Q000639:trends; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies
keywords: Abdominoperineal excision; Circumferential resection margin; Extralevator abdominoperineal excision; Neoadjuvant treatment; Rectal cancer