Improved quality of care for patients undergoing an abdominoperineal excision for rectal cancer
Improved quality of care for patients undergoing an abdominoperineal excision for rectal cancer
复制标题
DOI：
10.1016/j.ejso.2014.11.003
复制
发表时间：
2015-02-01
期刊：
影响因子：
3.8
通讯作者：
de Wilt, J. H. W.
中科院分区：
文献类型：
--
作者：
Bokkerink, G. M. J.;Buijs, E. F. M.;de Wilt, J. H. W.
前言：新的诊断方法、全直肠系膜切除术和新辅助治疗的出现改善了直肠癌患者的预后。远端直肠癌接受腹会切除术的患者似乎比那些采用括约肌保留术的患者表现得更差。本研究的目的是评估在过去的15年中，远端直肠癌患者接受腹会切除术的护理质量。材料和方法：对1996年12月至2010年12月在荷兰5家医院接受腹会切除术的所有直肠癌患者进行分析。患者被分成三个队列：1996-2001,2001-2005和2006-2010。所有数据均从病历中提取。结果：确定了477例患者。在性别、年龄、体重指数、既往盆腔手术和ASA分期方面，队列之间没有显著差异。MR[成为研究中的标准工具，使用率从第一组的4.5%上升到最后一组的95.1%(p<；0.0001)。新辅助治疗从以无为主(队列1中64.9%)转变为短程放疗(队列2中66.7%)和放化疗(队列3中55.7%)。队列中有环切切缘受累减少的趋势(18.8%、16.7%和11.4%；p=0.142)。意外肠穿孔显著减少，从28.6%，队列3的21.7%下降到9.2%(p<；0.0001)。结论：低位直肠癌腹会阴切除患者在工作、新辅助和手术治疗方面有了显著的改善。这些改进带来了更好的短期结果。(C)2014爱思唯尔有限公司。保留所有权利。
Introduction: 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.Materials and 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. MR[ 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).Conclusion: 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. (C) 2014 Elsevier Ltd. All rights reserved.