Brown Kilian G M, Solomon Michael J, Koh Cherry E, Sutton Paul A, Aguiar Samuel, Bezerra Tiago S, Clouston Hamish W, Desouza Ashwin, Dozois Eric J, Ersryd Amanda L, Frizelle Frank, Funder Jonas A, Garcia-Aguilar Julio, Garfinkle Richard, Glyn Tamara, Heriot Alexander, Kanemitsu Yukihide, Kong Chia Y, Kristensen Helle Ø, Malakorn Songphol, Mens David M, Nilsson Per J, Palmer Gabriella J, Pappou Emmanouil, Quinn Martha, Quyn Aaron J, Sahakitrungruang Chucheep, Saklani Avanish, Solbakken Arne M, Tiernan Jim P, Verhoef Cornelis, Steffens Daniel
Department of Colorectal Surgery and Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Sydney, Australia.
Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom.
Ann Surg. 2024 May 15. doi: 10.1097/SLA.0000000000006348.
To establish globally applicable benchmark outcomes for pelvic exenteration (PE) in patients with locally advanced primary (LARC) and recurrent rectal cancer (LRRC), using outcomes achieved at highly specialised centres.
PE is established as the standard of care for selected patients with LARC and LRRC. There are currently no available benchmarks against which surgical performance in PE can be compared for audit and quality improvement.
This international multicentre retrospective cohort study included patients undergoing PE for LARC or LRRC at 16 highly experienced centres between 2018 and 2023. Ten outcome benchmarks were established in a lower-risk subgroup. Benchmarks were defined by the 75th percentile of the results achieved at the individual centres.
763 patients underwent PE, of which 464 patients (61%) had LARC and 299 (39%) had LRRC. 544 patients (71%) who met predefined lower risk criteria formed the benchmark cohort. For LARC patients, the calculated benchmark threshold for major complication rate was ≤44%; comprehensive complication index (CCI): ≤30.2; 30-day mortality rate: 0%; 90-day mortality rate: ≤4.3%; R0 resection rate: ≥79%. For LRRC patients, the calculated benchmark threshold for major complication rate was ≤53%; CCI: ≤34.1; 30-day mortality rate: 0%; 90-day mortality rate: ≤6%; R0 resection rate: ≥77%.
The reported benchmarks for PE in patients with LARC and LRRC represent the best available care for this patient group globally and can be used for rigorous assessment of surgical quality and to facilitate quality improvement initiatives at international exenteration centres.
利用高度专业化中心所取得的成果，为局部晚期原发性直肠癌（LARC）和复发性直肠癌（LRRC）患者建立全球适用的盆腔廓清术（PE）基准结局。
PE已被确立为特定LARC和LRRC患者的护理标准。目前尚无可用的基准来比较PE手术表现，以供审计和质量改进。
这项国际多中心回顾性队列研究纳入了2018年至2023年间在16个经验丰富的中心接受LARC或LRRC的PE手术的患者。在一个低风险亚组中建立了10个结局基准。基准由各中心所取得结果的第75百分位数定义。
763例患者接受了PE手术，其中464例（61%）为LARC，299例（39%）为LRRC。544例（71%）符合预定义低风险标准的患者组成了基准队列。对于LARC患者，计算得出的主要并发症发生率基准阈值为≤44%；综合并发症指数（CCI）：≤30.2；30天死亡率：0%；90天死亡率：≤4.3%；R0切除率：≥79%。对于LRRC患者，计算得出的主要并发症发生率基准阈值为≤53%；CCI：≤34.1；30天死亡率：0%；90天死亡率：≤6%；R0切除率：≥77%。
所报告的LARC和LRRC患者PE基准代表了全球该患者群体可获得的最佳护理，可用于严格评估手术质量，并促进国际廓清术中心的质量改进举措。
