Department of General, Visceral and Thoracic Surgery, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, 01067, Dresden, Germany.
Department of Pathology, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Friedrichstr. 41, 01067, Dresden, Germany.
Int J Colorectal Dis. 2021 Mar;36(3):517-533. doi: 10.1007/s00384-020-03792-8. Epub 2020 Nov 9.
Centralization of cancer care is expected to yield superior results. In Germany, the national strategy is based on a voluntary certification process. The effect of centre certification is difficult to prove because quality data are rarely available prior to certification. This observational study aims to assess outcomes for rectal cancer patients before and after implementation of a certified cancer centre.
All consecutive patients treated for rectal cancer in our certified centre from 2009 to 2017 were retrieved from a prospective database. The dataset was analyzed according to a predefined set of 19 quality indicators comprising 36 quality goals. The results were compared to an identical cohort of patients, treated from 2000 to 2008 just before centre implementation.
In total, 1059 patients were included, 481 in the 2009-2017 interval and 578 in the 2000-2008 interval. From 2009 to 2017, 25 of 36 quality goals were achieved (vs. 19/36). The proportion of anastomotic leaks in low anastomoses was improved (13.5% vs. 22.1%, p = 0.018), as was the local 5-year recurrence rate for stage (y)pIII rectal cancers (7.7% vs. 17.8%, p = 0.085), and quality of mesorectal excision (0.3% incomplete resections vs. 5.5%, p = 0.002). Furthermore, a decrease of abdominoperineal excisions was noted (47.1% vs. 60.0%, p = 0.037). For the 2009-2017 interval, local 5-year recurrence rate in stages (y)p0-III was 4.6% and 5-year overall survival was 80.2%.
Certification as specialized centre and regular audits were associated with an improvement of various quality parameters. The formal certification process has the potential to enhance quality of care for rectal cancer patients.
集中治疗癌症有望取得更好的效果。在德国，国家战略基于自愿认证程序。由于在认证之前很少有质量数据可用，因此很难证明中心认证的效果。本观察性研究旨在评估在实施认证癌症中心前后直肠癌症患者的治疗结果。
从我们的认证中心 2009 年至 2017 年连续治疗的所有直肠癌症患者中提取了前瞻性数据库。根据包含 36 个质量目标的 19 个质量指标的预定集分析数据集。将结果与实施中心之前的 2000 年至 2008 年期间治疗的相同患者队列进行比较。
共纳入 1059 例患者，2009-2017 年期间 481 例，2000-2008 年期间 578 例。2009 年至 2017 年期间，实现了 36 个质量目标中的 25 个（25/36）。低位吻合吻合口漏的比例得到改善（13.5%比 22.1%，p = 0.018），分期（y）pIII 直肠癌症的局部 5 年复发率也得到改善（7.7%比 17.8%，p = 0.085），中直肠切除质量（0.3%不完全切除与 5.5%，p = 0.002）。此外，腹会阴切除术的数量减少（47.1%比 60.0%，p = 0.037）。对于 2009-2017 年期间，分期（y）p0-III 的局部 5 年复发率为 4.6%，5 年总生存率为 80.2%。
作为专门中心的认证和定期审核与各种质量参数的改善相关。正式的认证过程有可能提高直肠癌患者的护理质量。
