The Vermont Colorectal Cancer ProjectSelf-portrait
Neil Hyman
2002
Archives of Surgery
Hypothesis: A prospective statewide quality assessment and improvement project requiring active participation and case entry by surgeons is feasible provided that confidentiality and peer review protection are provided. Design: Inception cohort. Setting: Acute-care hospitals in Vermont. Patients: Consecutive series of 364 patients undergoing elective surgery for colorectal cancer between April 1, 1999, and March 31, 2001, who were prospectively entered into a database created by the Vermont
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... ter of the American College of Surgeons under peer review protection from the Vermont Program for Quality Health Care. Intervention: Surgery for invasive colorectal cancer. Main Outcome Measures: Case entry compliance, surgical complications, length of stay, demographics, cancerspecific characteristics, and use of adjuvant therapy. Results: The calculated case entry compliance rate was 78%. There were 7 deaths (2%) and 45 major complications in 39 patients (12.3%). All patients were offered referral for adjuvant therapy when appropriate based on National Institutes of Health Consensus Conference standards. Mean age was 68.7 years, and 52% of cancers occurred in women. The most common site of cancer was the right colon (36.6% of patients), and only 47.9% of malignancies were in the rectum or sigmoid. Eightytwo percent of patients had symptoms on presentation. Conclusions: Elective colorectal cancer surgery in Vermont is reasonably safe, and adherence to national standards for the use of adjuvant therapy is outstanding. Surgeons will provide outcome data if confidentiality and peer review protection are provided. The predominance of right-sided lesions and the low incidence of asymptomatic detection have significant implications for screening efforts in Vermont. Arch Surg. 2002;137:413-416 C OLORECTAL CANCER is the second most common cause of cancer-related mortality in the United States 1 and in Vermont. 2 Colon resections for cancer are performed by many different surgeons in most hospitals in the United States, 3 including all acute-care hospitals in Vermont. Considerable variation in outcome measures have been reported, suggesting improvement in high-volume hospitals 4,5 or in the hands of specialty-trained surgeons. 6, 7 However, these studies 4-7 are typically retrospective in nature, are not always population based, and may be subject to considerable reporting bias. The purpose of this study was to assess the feasibility of performing a quality study of the surgical management of colorectal cancer in Vermont using a surgeoninitiated, prospective database. A second-ary aim was to assess the implications of cancer demographics for colorectal cancer screening in a defined population. RESULTS In 2 years, 364 cases with both data forms completed were reported to the registry by 33 surgeons. There were 172 men and 192 women with a mean age of 68.7 years ( Table 1) . The most common tumor location was in the right colon (133 cases [36.6%]), followed by the rectum (97 cases [26.6%]) and the sigmoid colon (77 cases [21.2%]) (Figure) . Eighty-two percent of patients were symptomatic on presentation (eg, change in bowel habits, bleeding, and obstructive symptoms), whereas only 18% of cancers were detected by using colorectal cancer screening methods (guaiac positive stool or screening sigmoidoscopy or colonoscopy). There were no PAPER
doi:10.1001/archsurg.137.4.413
pmid:11926944
fatcat:iemngzb6trdlvoj2cnhyvffsyi