Rectal cancer surgeons 'using wrong op'
Variations in rectal cancer surgery were uncovered
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Thursday, 05, Jun 2008 09:37
Surgeons across England are not undertaking the most appropriate form of surgery for rectal cancer in all cases, a new study said today.
Researchers at the University of Leeds claim that a substantial proportion of rectal cancer patients are receiving inappropriate surgical care because of wide variations in practice across England.
Guidance from the Department of Health says surgeons should use, wherever possible, alternative methods to abdominoperineal excision (APE).
This used to be the most common approach to rectal cancer treatment but mounting evidence indicates that although APE is unavoidable in some patients, it should not be the preferred procedure for most of them.
Instead guidelines say anterior resection (AR) should be used if possible as it does not result in the need for a colostomy bag.
When the researchers studied the eight cancer registries in England between 1998 and 2004 they found that AR was not always selected when appropriate.
Rates of APE fell from almost one in three procedures (30.5 per cent) in 1998 to almost one in four (23 per cent) in 2004.
But there were wide variations in the use of APE among different cancer networks, individual surgeons and hospital trusts, where rates varied from 8.5 per cent to almost 53 per cent.
In 1998, one third of patients were operated on a by a surgeon who performed fewer than seven rectal cancer procedures in a year. By 2004, this had fallen to around one in four (26.5 per cent).
Patients treated by a specialist surgeon undertaking seven or more cases of rectal cancer a year were 23 per cent less likely to be treated with APE than those with less experience.
The figures, published in the journal Gut, also revealed that those living in the most deprived areas of the country were significantly more likely to receive an APE than those living in the most affluent areas.
The researchers conclude that the variations they uncovered are "concerning".
"Ultimately, this may result in some patients needlessly receiving a colostomy (potentially leading to a poorer quality of life), [having] a higher risk of a local recurrence and ultimately poorer survival," they add.
"It will also pose a significant financial burden to the NHS in terms of the ongoing maintenance costs of colostomies and treatment of local recurrence. These problems must be addressed if the government is to attain its aim of 'ensuring a high quality of cancer care for all'."