Simons A J, Ker R, Groshen S, Gee C, Anthone G J, Ortega A E, Vukasin P, Ross R K, Beart R W
Department of Surgery, University of Southern California School of Medicine and Norris Comprehensive Cancer Center, Los Angeles, USA.
Dis Colon Rectum. 1997 Jun;40(6):641-6. doi: 10.1007/BF02140891.
Surgical options for the treatment of rectal cancer may involve sphincter-sparing procedures (SSP) or abdominoperineal resection (APR). We sought to examine variations in the surgical treatment of rectal cancer for a large, well-defined patient population and specifically to determine if differences exist in management and survival based on hospital type and surgical caseload.
The Cancer Surveillance Program database for Los Angeles County was used to retrospectively retrieve data on all patients who underwent SSP or APR for rectal adenocarcinoma between 1988 and 1992.
A total of 2,006 patients with adenocarcinoma of the rectum underwent SSP or APR during the study period. Overall, 55 percent underwent SSP, and the remaining 45 percent underwent APR. Use of SSP remained relatively constant for each year of the five-year period. Substantial variability was seen in the use of SSP at various hospital types. For localized disease, this varied from as low as 52 percent at teaching hospitals to as high as 78 percent at hospitals approved by the American College of Surgeons (P = 0.067). To examine the role of caseload experience, hospitals were divided into those completing an average of five or fewer rectal cancer cases per year vs. those completing an average of more than five cases per year. For localized disease, hospitals with higher caseloads performed SSP in significantly more cases, 69 vs. 63 percent (P = 0.049). Survival was seen to be significantly improved for patients operated on at hospitals with higher caseloads, in cases of both localized and regional diseases (P < 0.001).
Surgical choices in the treatment of rectal cancer may vary widely, even in a well-defined geographic region. Although the reasons for this variability are multifactorial, hospital environment and surgical caseload experience seem to have a significant role in the choice of surgical procedure and on survival.
直肠癌的手术治疗选择可能包括保留括约肌手术（SSP）或腹会阴联合切除术（APR）。我们试图研究一大群明确界定的患者中直肠癌手术治疗的差异，特别是确定基于医院类型和手术病例数量在治疗管理和生存率方面是否存在差异。
使用洛杉矶县癌症监测项目数据库回顾性检索1988年至1992年间所有接受SSP或APR治疗直肠腺癌患者的数据。
在研究期间，共有2006例直肠腺癌患者接受了SSP或APR。总体而言，55%的患者接受了SSP，其余45%接受了APR。在这五年期间，每年SSP的使用相对稳定。不同医院类型在SSP的使用上存在很大差异。对于局限性疾病，这一比例从教学医院的低至52%到美国外科医师学会认可的医院的高达78%不等（P = 0.067）。为了研究病例数量经验的作用，医院被分为每年完成平均五例或更少直肠癌病例的医院与每年完成平均超过五例病例的医院。对于局限性疾病，病例数量较多医院进行SSP的比例明显更高，分别为69%和63%（P = 0.049）。在局限性和区域性疾病病例中，在病例数量较多医院接受手术的患者生存率明显提高（P < 0.001）。
即使在明确界定的地理区域内，直肠癌治疗中的手术选择也可能有很大差异。尽管这种差异的原因是多因素的，但医院环境和手术病例数量经验似乎在手术方式选择和生存率方面起重要作用。
