Wibe A, Eriksen M T, Syse A, Myrvold H E, Søreide O
Department of Surgery, University Hospital Trondheim, Trondheim N-7006, Norway.
Colorectal Dis. 2003 Sep;5(5):471-7. doi: 10.1046/j.1463-1318.2003.00506.x.
The results of rectal cancer surgery in Norway have been poor. In a national audit for the period 1986-88, 28% of the patients developed local recurrence (LR) following treatment with a curative intent. Five-year overall survival was 55% for patients younger than 75 years. The aim of this study is to report how an initiative focusing on better surgery can improve the prognosis for rectal cancer patients on a national level.
In 1994, the Norwegian Rectal Cancer Group was founded. The aim of this initiative was to improve the surgical standard by implementing total mesorectal excision (TME) on a national level and to evaluate the results. A number of courses were arranged to teach the surgeons the TME technique, and pathologists were trained to increase the standard of both macroscopic and microscopic assessment of specimens. A rectal cancer registry was established, and all surgical departments treating rectal cancer were invited to transfer their clinical data to this registry. Each department regularly receives its own results together with the national average for comparison and quality control.
The Rectal Cancer Registry includes all patients with rectal cancer diagnosed since November 1993. From then until December 1999, 5382 patients had a tumour located within 16 cm from the anal verge, and 3432 patients underwent rectal resection with a curative intent. Of these, 9% had adjuvant radiotherapy, and 2% were given chemotherapy. There was a rapid implementation of the new technique, as 78% underwent TME in 1994, increasing to 96% in 1998. After 39 months mean follow-up the rate of local recurrence was 8%, and 5-year overall survival was 71% for patients younger than 75 years.
An optimized surgical technique (TME) for rectal cancer can reduce the rate of local recurrence and increase overall survival. This improved surgical treatment can be implemented on a national level within a few years. Specialization of surgeons, feedback of results and a separate rectal cancer registry are thought to be major contributors to the improved treatment.
挪威直肠癌手术的结果一直不佳。在一项针对1986 - 1988年期间的全国性审计中，28%的患者在接受根治性治疗后出现局部复发（LR）。75岁以下患者的五年总生存率为55%。本研究的目的是报告一项专注于改进手术的举措如何在全国范围内改善直肠癌患者的预后。
1994年，挪威直肠癌小组成立。该举措的目的是通过在全国范围内实施全直肠系膜切除术（TME）来提高手术标准并评估结果。安排了一系列课程向外科医生传授TME技术，同时对病理学家进行培训以提高标本宏观和微观评估的标准。建立了直肠癌登记处，并邀请所有治疗直肠癌的外科科室将其临床数据传输至该登记处。每个科室定期收到自己的结果以及全国平均水平以供比较和质量控制。
直肠癌登记处涵盖了自1993年11月以来诊断出的所有直肠癌患者。从那时到1999年12月，5382例患者的肿瘤位于距肛缘16厘米以内，3432例患者接受了根治性直肠切除术。其中，9%的患者接受了辅助放疗，2%的患者接受了化疗。新技术得到了迅速推广，1994年78%的患者接受了TME，到1998年这一比例增至96%。经过平均39个月的随访，局部复发率为8%，75岁以下患者的五年总生存率为71%。
优化的直肠癌手术技术（TME）可降低局部复发率并提高总生存率。这种改进的手术治疗可在几年内在全国范围内实施。外科医生的专业化、结果反馈以及单独的直肠癌登记处被认为是治疗改善的主要因素。
