Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm
Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm
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DOI：
10.1016/s0140-6736(00)02469-7
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发表时间：
2000-07-08
期刊：
影响因子：
168.9
通讯作者：
Cedermark, B
中科院分区：
文献类型：
--
作者：
Martling, AL;Holm, T;Cedermark, B
背景斯德哥尔摩I和II期随机试验证实了术前放疗在预防直肠癌局部复发中的价值。本研究探讨了进一步改善的潜力，通过引进全直肠系膜切除术（TME）的概念，外科医生在斯德哥尔摩，Sweden.Methods研讨会开始于1994年，包括11个电视为基础的演示和两个组织病理学会议。研究人群包括1995-96年期间在斯德哥尔摩县接受直肠癌腹部手术的所有患者（TME项目; n=447）。2年的结果与斯德哥尔摩I（n=790）和11（n=542）试验作为历史对照进行了比较。结果对于根治性腹部切除术的患者，斯德哥尔摩1（n=686）、斯德哥尔摩II（n=481）和TME项目（n=381）组之间的30天死亡率没有差异（30例[4%]、6例[1%]和12例[3%]）、吻合口漏（27例[10%]、18例[9%]和23例[9%]）或所有并发症（204例[30%]、169例[35%]和134例[35%]）。尽管腹会阴手术的比例从55-60%降至27%，但仍实现了这种相似性。TME组的局部复发率明显低于斯德哥尔摩I组和II组（21例[6%] vs 103例[15%]和66例[14%]，p
Background The Stockholm I and II randomised trials demonstrated the value of preoperative radiotherapy in preventing local recurrence in rectal cancer. This study investigated the potential for further improvement by introduction of the concept of total mesorectal excision (TME) to surgeons in Stockholm, Sweden.Methods Workshops started in 1994 and included 11 television-based demonstrations and two histopathology sessions. The study population consisted of all patients who underwent abdominal operations for rectal cancer in Stockholm County during 1995-96 (TME project; n=447). Outcomes at 2 years were compared with those from the Stockholm I (n=790) and 11 (n=542) trials as historical controls.Findings For patients with curative abdominal resections, there were no differences between the Stockholm 1 (n=686), Stockholm II (n=481), and TME project (n=381) groups in 30-day mortality (30 [4%], six [1%], and 12 [3%]), anastomotic leakage (27 [10%], 18 [9%], and 23 [9%]), or all complications (204 [30%], 169 [35%], and 134 [35%]). This similarity was achieved despite a decrease in the proportion of abdominoperineal procedures from 55-60% to 27%. Local recurrence occurred in significantly fewer of the TME group than of the Stockholm I and II groups (21 [6%] vs 103 [15%] and 66 [14%], p