NORCCAG audit report 2011: mortality, survival and reconstructive rectal surgery David W Borowski for the members of the Northern Region Colorectal Cancer.

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NORCCAG audit report 2011: mortality, survival and reconstructive rectal surgery David W Borowski for the members of the Northern Region Colorectal Cancer Audit Group (NORCCAG)

Mortality & Survival 1 August 2007 – 31 July 2010 Abdominal resective surgery (n=3,526) Excluding TEMS, polypectomy, stoma only operations and per-anal excisions Patient-related factors 9 Cancer units Individual surgeons (mortality) > 20 CRC operations p.a. Pooled for low-volume surgeons

Mortality & Survival Elective mortality < 7 % Emergency mortality < 20 % Colorectal specialists MDT membership (2-3 surgeons / 200,000) Caseload (>20 curative resections / year)

Mortality 169/3,526 (4.8%) Deaths%p* Sex0.251 Female634.3 Male Age<0.001 < ≥ Unknown199.5 ASA grade<0.001 I20.5 II322.1 III707.6 IV V375.0 unknown336.0 Deaths%p* Tumour site0.011 Right colon826.2 Left colon504.1 Rectum373.8 Dukes’ stage<0.001 A172.9 B564.9 C544.7 “D” Unknown164.0 Urgency<0.001 Elective / planned963.4 Emergency / urgent Unknown167.5

Mortality 169/3,526 (4.8%) OR95% CIp Sex Female1.0 Male – Age < – – 6.66<0.001 ≥ – Unknown – 8.55<0.001 ASA grade I1.0 II – III – IV – 98.95<0.001 V – 3,18<0.001 unknown – OR95% CIp Tumour site Right colon1.0 Left colon – Rectum – Dukes’ stage A1.0 B – C – “D” – Unknown – Urgency Elective / planned1.0 Emergency / urgent – 3.65<0.001 Unknown –

Cancer units UnitAll resectionsElectiveEmergency DeathsResections%DeathsResections%DeathsResections% All

Consultant teams ConsultantAll resectionsElectiveEmergency CodeDeathsResections%DeathsResections%DeathsResections% // Pool missing Total

Consultant information

2-year Survival 79.1%

Cancer units UnitAll resectionsElectiveEmergency DeathsAlive*% OSDeathsAlive*% OSDeathsAlive*% OS All * Numbers at risk remaining in the analysis at 2 years, excluding censored patients

Rectal restoration 1 April 2006 – 31 July 2010 n=2,217 RC patients 1,752 (79.0%) surgery 1,334 (76.1%) abdominal resections < 30 % APER (+ Hartmanns)

Rectal surgery (n=1,752) OperationAbdominal resectionLocal ExcisionNo resectionUnknown Anterior Resection322 (24.1%) Anterior Resection & covering stoma490 (36.7%) APER342 (25.6%) Hartmanns100 (7.5%) Panproctocolectomy16 (1.2%) Per-anal Excision / Polypectomy / TEMS88 (100%) Stoma only86 (42.3%) Stent28 (13.7%) Other64 (4.8%)89 (43.8%) Not given127 (100%) All1,

Rectal surgery (n=1,752)

Rectal surgery (n=1,334)

Summary Operative mortality rates vary throughout the region between surgeons and cancer units, but are generally within the accepted range 2-year survival rates also show variation between cancer units Rates of rectal restoration vary greatly between cancer units, and appear to be outside the recommended minimum of 70% in some units Inaccurrate and incomplete data collection complicates, and potentially biases, the data analysis