Simunovic Marko, Grubac Vanja, Hillis Christopher, Yang Ilun, Eskicioglu Cagla, Bogach Jessica, Kennedy Erin, Porter Geoff, Fahim Christine, Wright James, Aziz Tariq, Tsai Scott, van der Pol Christian B, Devereaux P J, Baker G R
Department of Surgery, McMaster University, Hamilton, ON, Canada.
Department of Oncology, McMaster University, Hamilton, ON, Canada.
Ann Surg Oncol. 2022 Feb;29(2):1182-1191. doi: 10.1245/s10434-021-10651-5. Epub 2021 Sep 5.
For patients undergoing rectal cancer surgery, we evaluated whether suboptimal preoperative surgeon evaluation of resection margins is a latent condition factor-a factor that is common, unrecognized, and may increase the risk of certain adverse events, including local tumour recurrence, positive surgical margin, nontherapeutic surgery, and in-hospital mortality.
In this observational case series of patients who underwent rectal cancer surgery during 2016 in Local Health Integrated Network 4 region of Ontario (population 1.4 million), chart review and a trigger tool were used to identify patients who experienced the adverse events. An expert panel adjudicated whether each event was preventable or nonpreventable and identified potential contributing factors to adverse events.
Among 173 patients, 25 (14.5%) had an adverse event and 13 cases (7.5%) were adjudicated as preventable. Rate of surgeon awareness of preoperative margin status was low at 50% and similar among cases with and without an adverse event (p = 0.29). Suboptimal surgeon preoperative evaluation of surgical margins was adjudicated a contributing factor in all 11 preventable local recurrence, positive margin, and nontherapeutic surgery cases. Failure to rescue was judged a contributing factor in the two cases with preventable in-hospital mortality.
Suboptimal surgeon preoperative evaluation of surgical margins in rectal cancer is likely a latent condition factor. Optimizing margin evaluation may be an efficient quality improvement target.
对于接受直肠癌手术的患者，我们评估了术前外科医生对切缘的评估欠佳是否是一个潜在状况因素——一个常见、未被识别且可能增加某些不良事件风险的因素，这些不良事件包括局部肿瘤复发、手术切缘阳性、非治疗性手术和住院死亡率。
在安大略省第4地方卫生综合网络区域（人口140万）2016年接受直肠癌手术的患者的这个观察性病例系列中，通过病历审查和一种触发工具来识别经历不良事件的患者。一个专家小组判定每个事件是否可预防，并确定不良事件的潜在促成因素。
在173例患者中，25例（14.5%）发生了不良事件，13例（7.5%）被判定为可预防。外科医生对术前切缘状态的知晓率较低，为50%，在有和没有不良事件的病例中相似（p = 0.29）。在所有11例可预防的局部复发、切缘阳性和非治疗性手术病例中，外科医生术前对手术切缘的评估欠佳被判定为一个促成因素。在两例可预防的住院死亡病例中，未能挽救被判定为一个促成因素。
直肠癌手术中外科医生术前对手术切缘的评估欠佳可能是一个潜在状况因素。优化切缘评估可能是一个有效的质量改进目标。
