Bianco Francesco, De Franciscis Silvia, Belli Andrea, Di Lena Maria, Avallone Antonio, Bianco Maria Antonia, Di Marzo Sabato, Gigli Letizia, Rotondano Gianluca, Spena Silvana Russo, Tatangelo Fabiana, Tempesta Alfonso, Romano Giovanni Maria
Department of Surgical Oncology, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione Giovanni Pascale" - IRCCS, Via M. Semmola, 80131, Naples, Italy.
Department of Medical Oncology, Istituto Nazionale per lo studio e la cura dei tumori "Fondazione Giovanni Pascale" - IRCCS, Naples, Italy.
Int J Colorectal Dis. 2016 Mar;31(3):587-92. doi: 10.1007/s00384-015-2472-7. Epub 2015 Dec 29.
From 2011 to 2013 in the area of the Naples 3 public health district (ASL-NA3), a colorectal cancer screening program (CCSP) was developed. In order to stress the need of quality assurance procedures for surgery and pathology, a third level oncologic pathway was added and set up at a referral colorectal cancer center (RC). Lymph nodal (LN) harvesting, as a process indicator, and nodal positivity were adopted for an interim analysis.
The program was implemented by a series of audit meetings and a double type of multidisciplinary team (MDT): "horizontal" and "vertical." Three hundred and forty colorectal cancer (CRC) patients underwent surgery: 119 chose to be operated at the RC (Gr In), 65 were operated at 22 district hospitals (DH) (Gr Out), and 156 symptomatic not screened patients were operated at the RC (Gr Sym).
Statistical analysis revealed differences between Gr In and Gr Out colon groups both for LN harvesting (median of 26 and 11, respectively, P = 0.0001), and for nodal positivity after the first screening round (34.78 and 19.45%, respectively, P = 0.0169). Results were all the more significant in a subset analysis on early T stage colon subgroups (In vs Out) both for LN harvesting (P < 0.0001) and nodal positivity (P < 0.0001).
xSignificant differences between RC and DHs were found, particularly for early-stage CRC patients. LN harvesting should be considered as a surrogate marker of quality assurance for at least screening hospitals for "minimum best" standard of care. This should lead to set up a third level in any CCSP.
2011年至2013年期间，在那不勒斯第三公共卫生区（ASL-NA3）开展了一项结直肠癌筛查项目（CCSP）。为强调手术和病理学质量保证程序的必要性，在一家转诊结直肠癌中心（RC）增设并建立了三级肿瘤学诊疗路径。采用淋巴结（LN）清扫作为过程指标，并将淋巴结阳性情况用于中期分析。
该项目通过一系列审核会议以及两种类型的多学科团队（MDT）实施：“横向”和“纵向”。340例结直肠癌（CRC）患者接受了手术：119例选择在转诊中心（Gr In）手术，65例在22家地区医院（DH）手术（Gr Out），156例有症状的未筛查患者在转诊中心手术（Gr Sym）。
统计分析显示，Gr In组和Gr Out组结肠癌患者在LN清扫方面存在差异（中位数分别为26和11，P = 0.0001），在首轮筛查后的淋巴结阳性情况方面也存在差异（分别为34.78%和19.45%，P = 0.0169）。在早期T分期结肠癌亚组（In组与Out组）的子集分析中，LN清扫（P < 0.0001）和淋巴结阳性情况（P < 0.0001）的结果差异更为显著。
发现转诊中心和地区医院之间存在显著差异，尤其是对于早期CRC患者。LN清扫应被视为至少筛查医院护理“最低最佳”标准质量保证的替代指标。这应促使在任何CCSP中设立三级诊疗路径。
