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. 2020 Apr;22(4):416-429.
doi: 10.1111/codi.14903. Epub 2019 Nov 27.

International evaluation of circumferential resection margins after rectal cancer resection: insights from the Swedish and Dutch audits

R Detering  1   2 , D Saraste  3 , M P M de Neree Tot Babberich  2   4 , J W T Dekker  5 , M W J M Wouters  2   6 , A A W van Geloven  7 , W A Bemelman  1 , P J Tanis  1 , A Martling  3 , M Westerterp  8 ; Swedish ColoRectal Cancer Registry and the Dutch ColoRectal Audit
Collaborators, Affiliations

International evaluation of circumferential resection margins after rectal cancer resection: insights from the Swedish and Dutch audits

R Detering et al. Colorectal Dis. 2020 Apr.

Abstract

Aim: This study aimed to determine predictive factors for the circumferential resection margin (CRM) within two northern European countries with supposed similarity in providing rectal cancer care.

Method: Data for all patients undergoing rectal resection for clinical tumour node metastasis (TNM) stage I-III rectal cancer were extracted from the Swedish ColoRectal Cancer Registry and the Dutch ColoRectal Audit (2011-2015). Separate analyses were performed for cT1-3 and cT4 stage. Predictive factors for the CRM were determined using univariable and multivariable logistic regression analyses.

Results: A total of 6444 Swedish and 12 089 Dutch patients were analysed. Over time the number of hospitals treating rectal cancer decreased from 52 to 42 in Sweden, and 82 to 79 in the Netherlands. In the Swedish population, proportions of cT4 stage (17% vs 8%), multivisceral resection (14% vs 7%) and abdominoperineal excision (APR) (37% vs 31%) were higher. The overall proportion of patients with a positive CRM (CRM+) was 7.8% in Sweden and 5.4% in the Netherlands. In both populations with cT1-3 stage disease, common independent risk factors for CRM+ were cT3, APR and multivisceral resection. No common risk factors for CRM+ in cT4 stage disease were found. An independent impact of hospital volume on CRM+ could be demonstrated for the cT1-3 Dutch population.

Conclusion: Within two northern European countries with implemented clinical auditing, rectal cancer care might potentially be improved by further optimizing the treatment of distal and locally advanced rectal cancer.

Keywords: Netherlands; Rectal neoplasms; Sweden; colorectal surgery; hospitals; surgical margin.

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Conflict of interest statement

RD, DS, MPMdNtB, JWTD, MWJMW, NAWvG, WAB, PJT, AM and MW have no conflicts of interest or financial ties to disclose.

Figures

Figure 1
Figure 1
Number of hospitals performing rectal cancer surgery in Sweden and the Netherlands, categorized into four hospital volume groups during the years 2011–2015.
Figure 2
Figure 2
(a) Funnelplot of CRM involvement for case mix‐corrected Swedish/Dutch hospitals performing rectal cancer (cT1–3) surgery (2011–2015). The following factors were included to correct for differences in case mix between patients: sex, BMI, pathological T status, setting, approach and multivisceral resection, preoperative radiotherapy. (b) Funnelplot of CRM involvement for case mix‐corrected Swedish/Dutch hospitals performing rectal cancer (cT4) surgery (2011–2015). The following factors were included to correct for differences in case mix between patients: sex, BMI, pathological T status, setting, approach and multivisceral resection, preoperative radiotherapy.
See this image and copyright information in PMC

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