Department of Epidemiology & Cancer Registry, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada.
Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P5, Canada.
Curr Oncol. 2021 Jun 16;28(3):2239-2247. doi: 10.3390/curroncol28030206.
Unwarranted clinical variation in healthcare impacts access, productivity, performance, and outcomes. A strategy proposed for reducing unwarranted clinical variation is to ensure that population-based data describing the current state of health care services are available to clinicians and healthcare decision-makers. The objective of this study was to measure variation in colorectal cancer surgical treatment patterns and surgical quality in Manitoba and identify areas for improvement. This descriptive study included individuals aged 20 years or older who were diagnosed with invasive cancer (adenocarcinoma) of the colon or rectum between 1 January 2010 and 31 December 2014. Laparoscopic surgery was higher in colon cancer (24.1%) compared to rectal cancer (13.6%). For colon cancer, the percentage of laparoscopic surgery ranged from 12.9% to 29.2%, with significant differences by regional health authority (RHA) of surgery. In 86.1% of colon cancers, ≥12 lymph nodes were removed. In Manitoba, the negative circumferential resection margin for rectal cancers was 96.9%, and ranged from 96.0% to 100.0% between RHAs. The median time between first colonoscopy and resection was 40 days for individuals with colon cancer. This study showed that high-quality colorectal cancer surgery is being conducted in Manitoba along with some variation and gaps in quality. As a result of this work, a formal structure for ongoing measuring and reporting surgical quality has been established in Manitoba. Quality improvement initiatives have been implemented based on these findings and periodic assessments of colorectal cancer surgery quality will continue.
医疗保健中的不必要临床差异会影响获得治疗的机会、生产力、绩效和结果。为减少不必要的临床差异而提出的一项策略是，确保临床医生和医疗保健决策者能够获得描述当前医疗服务状况的基于人群的数据。本研究的目的是测量马尼托巴省结直肠癌手术治疗模式和手术质量的差异，并确定需要改进的领域。本描述性研究纳入了 20 岁或以上在 2010 年 1 月 1 日至 2014 年 12 月 31 日期间被诊断患有结肠或直肠浸润性癌（腺癌）的个体。腹腔镜手术在结肠癌（24.1%）中高于直肠癌（13.6%）。对于结肠癌，腹腔镜手术的比例从 12.9%到 29.2%不等，手术的区域卫生当局（RHA）之间存在显著差异。在 86.1%的结肠癌中，至少切除了 12 个淋巴结。在马尼托巴省，直肠癌的阴性环周切缘为 96.9%，各 RHA 之间的范围为 96.0%至 100.0%。首次结肠镜检查和切除之间的中位时间为结肠癌患者 40 天。本研究表明，马尼托巴省正在进行高质量的结直肠癌手术，但在质量方面存在一些差异和差距。由于这项工作，马尼托巴省已经建立了一个用于持续衡量和报告手术质量的正式结构。已经根据这些发现实施了质量改进举措，并将继续定期评估结直肠癌手术质量。
