European Journal of Surgical Oncology
Volume 36, Issue 4 , Pages 340-344, April 2010

Quality assurance in rectal cancer treatment in the Netherlands: A catch up compared to colon cancer treatment☆

  • W. van Gijn

      Affiliations

    • Department of Surgery, Leiden University Medical Center, K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands
    • ,
  • P. Krijnen

      Affiliations

    • Leiden Cancer Registry, Comprehensive Cancer Centre West (IKW), Leiden, The Netherlands
    • ,
  • V.E.P.P. Lemmens

      Affiliations

    • Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), Eindhoven, The Netherlands
    • ,
  • M. den Dulk

      Affiliations

    • Department of Surgery, Haga Hospital, The Hague, The Netherlands
    • ,
  • H. Putter

      Affiliations

    • Department of Statistics, Leiden University Medical Center, Leiden, The Netherlands
    • ,
  • C.J.H. van de Velde

      Affiliations

    • Department of Surgery, Leiden University Medical Center, K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands
    • Corresponding Author InformationCorresponding author. Tel.: +31 71 526 2309; fax: +31 71 526 6750.

Accepted 19 October 2009.

Abstract 

Background

In the Netherlands, the Total Mesorectal Excision (TME) surgical technique for rectal cancer was introduced together with pre-operative radiotherapy in a quality controlled manner within the framework of the TME trial (1996–1999). The aim of this study is to examine the effects of the structural changes in rectal cancer care on survival compared to colon cancer for patients treated before, during and after the TME trial.

Method

We compared overall survival of all patients with curatively resected colon (n = 15,266) and rectal cancer (n = 5839) in the regions of Comprehensive Cancer Centres South and West between 1990 and 2005, adjusting for prognostic variables.

Results

In the pre-trial period, rectal cancer had a significant lower survival compared to colon cancer (HR 1.248, P < 0.01). However, in the post-trial period, survival after rectal cancer was similar to colon cancer (HR 0.987, n.s.).

Conclusion

Although survival improved significantly for both colon and rectal cancer in the last 15 years, the substantially worse results after rectal cancer have been eliminated. This study shows the lasting effects that structural surgical training and quality assurance can have on survival outcome.

Keywords: Rectal cancer, Colon cancer, Colorectal cancer, quality assurance, outcome assessment, Survival

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☆ W. van Gijn is supported by a joint ECCO fellowship funded by ESSO, ESTRO and EORTC.

PII: S0748-7983(09)00494-6

doi:10.1016/j.ejso.2009.10.010

European Journal of Surgical Oncology
Volume 36, Issue 4 , Pages 340-344, April 2010

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