Department of Surgery, Leiden University Medical Center, K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Eur J Surg Oncol. 2010 Apr;36(4):340-4. doi: 10.1016/j.ejso.2009.10.010. Epub 2009 Nov 26.
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.
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.
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.).
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.
在荷兰，直肠癌的全直肠系膜切除术（TME）手术技术与术前放疗一起，在 TME 试验（1996-1999 年）的框架内以质量控制的方式引入。本研究旨在检查与结肠癌相比，在 TME 试验之前、期间和之后接受治疗的患者的直肠癌治疗中结构变化对生存的影响。
我们比较了 1990 年至 2005 年间综合癌症中心南区和西区所有接受根治性切除的结肠癌（n=15266）和直肠癌（n=5839）患者的总生存率，并对预后变量进行了调整。
在试验前阶段，直肠癌的生存率明显低于结肠癌（HR 1.248，P<0.01）。然而，在试验后阶段，直肠癌的生存率与结肠癌相似（HR 0.987，n.s.）。
尽管在过去的 15 年中，结肠癌和直肠癌的生存率都显著提高，但直肠癌的结果仍然明显较差。本研究表明，结构外科培训和质量保证可以对生存结果产生持久的影响。
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