Dutch ColoRectal Audit (DCRA), Leiden, Netherlands.
Bowel Cancer Outcomes Registry (BCOR), Melbourne, Australia.
Int J Colorectal Dis. 2024 Jan 6;39(1):15. doi: 10.1007/s00384-023-04578-4.
Surgical approach to rectal cancer has evolved in recent decades, with introduction of minimally invasive surgery (MIS) techniques and local excision. Since implementation might differ internationally, this study is aimed at evaluating trends in surgical approach to rectal cancer across different countries over the last 10 years and to gain insight into patient, tumour and treatment characteristics.
Pseudo-anonymised data of patients undergoing resection for rectal cancer between 2010 and 2019 were extracted from clinical audits in the Netherlands (NL), Sweden (SE), England-Wales (EW) and Australia-New Zealand (AZ).
Ninety-nine thousand five hundred ninety-seven patients were included (38,413 open, 55,155 MIS and 5416 local excision). An overall increase in MIS was observed from 29.9% in 2010 to 72.1% in 2019, with decreasing conversion rates (17.5-9.0%). The MIS proportion was highly variable between countries in the period 2010-2014 (54.4% NL, 45.3% EW, 39.8% AZ, 14.1% SE, P < 0.001), but variation reduced over time (2015-2019 78.8% NL, 66.3% EW, 64.3% AZ, 53.2% SE, P < 0.001). The proportion of local excision for the two periods was highly variable between countries: 4.7% and 11.8% in NL, 3.9% and 7.4% in EW, 4.7% and 4.6% in AZ, 6.0% and 2.9% in SE.
Application and speed of implementation of MIS were highly variable between countries, but each registry demonstrated a significant increase over time. Local excision revealed inconsistent trends over time.
近几十年来，直肠癌的手术方法不断发展，引入了微创外科（MIS）技术和局部切除术。由于国际上的实施情况可能存在差异，本研究旨在评估过去 10 年不同国家直肠癌手术方法的趋势，并深入了解患者、肿瘤和治疗特征。
从荷兰（NL）、瑞典（SE）、英格兰-威尔士（EW）和澳大利亚-新西兰（AZ）的临床审计中提取 2010 年至 2019 年间接受直肠癌切除术的患者的伪匿名数据。
共纳入 99597 例患者（38413 例开放性手术、55155 例 MIS 和 5416 例局部切除术）。观察到 MIS 的总体比例从 2010 年的 29.9%增加到 2019 年的 72.1%，同时转换率降低（17.5-9.0%）。2010-2014 年间，各国间 MIS 比例差异很大（NL 为 54.4%，EW 为 45.3%，AZ 为 39.8%，SE 为 14.1%，P<0.001），但随着时间的推移，差异逐渐减少（2015-2019 年 NL 为 78.8%，EW 为 66.3%，AZ 为 64.3%，SE 为 53.2%，P<0.001）。两个时期的局部切除术比例在各国之间差异很大：NL 为 4.7%和 11.8%，EW 为 3.9%和 7.4%，AZ 为 4.7%和 4.6%，SE 为 6.0%和 2.9%。
MIS 的应用和实施速度在各国之间存在很大差异，但每个登记处都显示出随着时间的推移显著增加。局部切除术的趋势随时间变化不一致。
