Jannasch O, Udelnow A, Romano G, Dziki A, Pavalkis D, Lippert H, Mroczkowski P
Department of General, Abdominal and Vascular Surgery, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany.
Langenbecks Arch Surg. 2014 Apr;399(4):473-9. doi: 10.1007/s00423-014-1176-8. Epub 2014 Feb 28.
Several European countries are undertaking quality control projects in colorectal cancer. These efforts have led to improvements in survival, but a comparison between different projects reveals questionable results. The aim of this study is the presentation of results from hospitals in three different European countries participating in the International Quality Assurance in Colorectal Cancer (IQACC) project.
For this publication, patients with cancer of the colon or rectum treated in 2009 and 2010 and recorded in the IQACC (Germany, Poland and Italy) were analysed. The comparison included number of patients, age, preoperative diagnostics (CT of the abdomen and thorax, MRI, colonoscopy, ultrasound, tumour markers), surgical approach, metastasis, height of rectal cancer and histopathological examination of a specimen (T stage, N stage and MERCURY classification for rectum resection). For short-term outcomes, general complications, wound dehiscence, tumour-free status at discharge, anastomotic leakage and in-hospital mortality were analysed.
A total of 12,691 patients (6,756 with colon cancer, 5,935 with rectal cancer) were included in the analysis. Preoperative diagnostics differed significantly between countries. For pT and pN stages, several quality differences could be demonstrated, including missing stages (colon cancer: pT 5.7-12.5 %, pN 2.5-11.0 %; rectal cancer: pT 1.1-5.6 %, pN 1.1-15.5 %). The most relevant differences for short-term outcomes in colon cancer were found in general complications (4.2-22.8 %) and tumour-free status at discharge (74.5-91.7 %). In-hospital deaths ranged between 2.5 and 4.3 % and did not show significant differences. For rectal cancer, the country with the highest percentage of tumours localised less than 4 cm from the anal verge (16.0 %) showed the lowest frequency of amputation (8.5 %). Outcome differences were found for general complications (3.2-18.8 %), anastomotic leakage (0-4.3 %) and tumour-free status at discharge (72.9-87.6 %). In-hospital deaths ranged between 1.1 and 3.2 %.
This study demonstrates the feasibility of an international quality assurance project in colorectal cancer. This concept ensures data analysis based on a comparable data input. Differences in preoperative diagnostics, completeness of histopathological evaluation and short-term outcomes for Germany, Poland and Italy might result from disparities in socioeconomic factors and implementation of existing guidelines. Further activities are necessary to warrant the use of common standards in outcome control.
几个欧洲国家正在开展结直肠癌质量控制项目。这些努力已使生存率有所提高，但不同项目之间的比较结果却存在问题。本研究的目的是展示来自三个不同欧洲国家参与国际结直肠癌质量保证（IQACC）项目的医院的结果。
对于本出版物，分析了2009年和2010年在IQACC（德国、波兰和意大利）中记录的接受结肠或直肠癌治疗的患者。比较内容包括患者数量、年龄、术前诊断（腹部和胸部CT、MRI、结肠镜检查、超声、肿瘤标志物）、手术方式、转移情况、直肠癌高度以及标本的组织病理学检查（T分期、N分期和直肠切除的MERCURY分类）。对于短期结果，分析了一般并发症、伤口裂开、出院时无瘤状态、吻合口漏和住院死亡率。
共有12,691例患者（6,756例结肠癌患者，5,935例直肠癌患者）纳入分析。各国术前诊断存在显著差异。对于pT和pN分期，可以证明存在一些质量差异，包括分期缺失（结肠癌：pT 5.7 - 12.5%，pN 2.5 - 11.0%；直肠癌：pT 1.1 - 5.6%，pN 1.1 - 15.5%）。结肠癌短期结果中最相关的差异在于一般并发症（4.2 - 22.8%）和出院时无瘤状态（74.5 - 91.7%）。住院死亡率在2.5%至4.3%之间，未显示出显著差异。对于直肠癌，肿瘤距肛缘小于4 cm的比例最高的国家（16.0%）截肢频率最低（8.5%）。在一般并发症（3.2 - 18.8%）、吻合口漏（0 - 4.3%）和出院时无瘤状态（72.9 - 87.6%）方面发现了结果差异。住院死亡率在1.1%至3.2%之间。
本研究证明了国际结直肠癌质量保证项目的可行性。这一概念确保了基于可比数据输入的数据分析。德国、波兰和意大利在术前诊断、组织病理学评估的完整性以及短期结果方面的差异可能源于社会经济因素和现有指南实施情况的不同。需要进一步开展活动以保证在结果控制中使用共同标准。
