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Surgical quality in colorectal cancer

OBJECTIVE: To determine the quality of surgical management offered to patients with colorectal cancer (CRC) as measured by adequacy of nodal resections and compare variations across the major hospitals in Jamaica. METHOD: Data was obtained from the CRC Registry of patients diagnosed and treated surg...

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Autores principales: Plummer, Joseph M., Williams, Nadia, Leake, Pierre-Anthony, Ferron-Boothe, Doreen, Meeks-Aitken, Nicola, Mitchell, Derek I., McFarlane, Michael E., East, Jeffery
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708073/
https://www.ncbi.nlm.nih.gov/pubmed/26862396
http://dx.doi.org/10.1016/j.amsu.2015.12.045
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author Plummer, Joseph M.
Williams, Nadia
Leake, Pierre-Anthony
Ferron-Boothe, Doreen
Meeks-Aitken, Nicola
Mitchell, Derek I.
McFarlane, Michael E.
East, Jeffery
author_facet Plummer, Joseph M.
Williams, Nadia
Leake, Pierre-Anthony
Ferron-Boothe, Doreen
Meeks-Aitken, Nicola
Mitchell, Derek I.
McFarlane, Michael E.
East, Jeffery
author_sort Plummer, Joseph M.
collection PubMed
description OBJECTIVE: To determine the quality of surgical management offered to patients with colorectal cancer (CRC) as measured by adequacy of nodal resections and compare variations across the major hospitals in Jamaica. METHOD: Data was obtained from the CRC Registry of patients diagnosed and treated surgically for CRC during the 3-year period commencing January 1, 2011. Variables analyzed included tumor site, stage and number of lymph nodes resected across hospitals. RESULTS: During the period under review 60% (349) of 586 patients had resections and formed the basis of this study. Of these 49% were treated at the UHWI, 27% from the KPH and STH, 15% from CRH and MRH and 8% from a private laboratory (DPS). Patient distribution was similar at UHWI compared to the others with mean age (61 vs 62) and with slightly more women having surgery (53% Vs 54%) (UHWI vs Others). For tumor grade, margin status, lymphovascular and depth of invasion (majority T3) there was no difference between UHWI and the other sites, although a smaller percentage of tumors treated at UHWI had Crohn's like reaction (p = 0.01). There was a larger proportion of sigmoid cancer at UHWI while the reverse trend was seen in cancers of the rectum (p = 0.027). The tumors treated at UHWI have a larger median number of regional nodes when compared to the other facilities (14 vs 10; p < 0.001) and also more likely to have positive nodes, as were women and younger patients. Comparison across facilities revealed that the proportion of tumors classed as well differentiated, circumferential margin involvement, and having lymphovascular invasion were higher for specimens processed at the private facility (p = 0.021, 0.035, 0.01 respectively). Histopathology reports of tumors treated at UHWI and DPS had median 14 and 18 nodes respectively while at NPH laboratory and CRH they were 9 and 10 respectively (p < 0.001), whilst those of the ascending, descending, sigmoid colon and rectum had median 15, 11, 13, 11 nodes respectively (p < 0.001). CONCLUSIONS: This review demonstrates measurable differences in the surgery and histopathological reports for CRC patients treated across the island. Given adjuvant treatment and prognostic implications there is room for improvement.
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spelling pubmed-47080732016-02-09 Surgical quality in colorectal cancer Plummer, Joseph M. Williams, Nadia Leake, Pierre-Anthony Ferron-Boothe, Doreen Meeks-Aitken, Nicola Mitchell, Derek I. McFarlane, Michael E. East, Jeffery Ann Med Surg (Lond) Original Research OBJECTIVE: To determine the quality of surgical management offered to patients with colorectal cancer (CRC) as measured by adequacy of nodal resections and compare variations across the major hospitals in Jamaica. METHOD: Data was obtained from the CRC Registry of patients diagnosed and treated surgically for CRC during the 3-year period commencing January 1, 2011. Variables analyzed included tumor site, stage and number of lymph nodes resected across hospitals. RESULTS: During the period under review 60% (349) of 586 patients had resections and formed the basis of this study. Of these 49% were treated at the UHWI, 27% from the KPH and STH, 15% from CRH and MRH and 8% from a private laboratory (DPS). Patient distribution was similar at UHWI compared to the others with mean age (61 vs 62) and with slightly more women having surgery (53% Vs 54%) (UHWI vs Others). For tumor grade, margin status, lymphovascular and depth of invasion (majority T3) there was no difference between UHWI and the other sites, although a smaller percentage of tumors treated at UHWI had Crohn's like reaction (p = 0.01). There was a larger proportion of sigmoid cancer at UHWI while the reverse trend was seen in cancers of the rectum (p = 0.027). The tumors treated at UHWI have a larger median number of regional nodes when compared to the other facilities (14 vs 10; p < 0.001) and also more likely to have positive nodes, as were women and younger patients. Comparison across facilities revealed that the proportion of tumors classed as well differentiated, circumferential margin involvement, and having lymphovascular invasion were higher for specimens processed at the private facility (p = 0.021, 0.035, 0.01 respectively). Histopathology reports of tumors treated at UHWI and DPS had median 14 and 18 nodes respectively while at NPH laboratory and CRH they were 9 and 10 respectively (p < 0.001), whilst those of the ascending, descending, sigmoid colon and rectum had median 15, 11, 13, 11 nodes respectively (p < 0.001). CONCLUSIONS: This review demonstrates measurable differences in the surgery and histopathological reports for CRC patients treated across the island. Given adjuvant treatment and prognostic implications there is room for improvement. Elsevier 2015-12-15 /pmc/articles/PMC4708073/ /pubmed/26862396 http://dx.doi.org/10.1016/j.amsu.2015.12.045 Text en © 2015 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
Plummer, Joseph M.
Williams, Nadia
Leake, Pierre-Anthony
Ferron-Boothe, Doreen
Meeks-Aitken, Nicola
Mitchell, Derek I.
McFarlane, Michael E.
East, Jeffery
Surgical quality in colorectal cancer
title Surgical quality in colorectal cancer
title_full Surgical quality in colorectal cancer
title_fullStr Surgical quality in colorectal cancer
title_full_unstemmed Surgical quality in colorectal cancer
title_short Surgical quality in colorectal cancer
title_sort surgical quality in colorectal cancer
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708073/
https://www.ncbi.nlm.nih.gov/pubmed/26862396
http://dx.doi.org/10.1016/j.amsu.2015.12.045
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