Impact of Specialisation in the Practice of Rectal Cancer Surgery at a District General Hospital

Aim: The aim of this study was to examine changes in the practice of rectal cancer surgery following the development of a specialist colorectal service.

Methods: Retrospective analysis of rectal cancer excisions between January 1995-June 2002; this time frame was divided into three equal periods of 2.5 years. The 1st time period was prior to the establishment of the colorectal unit. Colorectal surgeons performed all operations in the third period.

Results: 110 (male=70; female=40) patients were included; the number of operations performed increased over the 3 time periods (1st: n=17; 2nd: n=34; 3rd: n=59). Colorectal surgeons performed fewer APR's (23% vs.63.2%: p<0.005*), created fewer permanent stomas (40% vs. 80%:p<0.005*), and removed more than 8 nodes in a greater proportion of patients (58.9% vs. 25.0%: p<0.01*) compared to the general surgeons. No difference was noted between the two groups with regards positive circumferential margins (26.1% vs.16.6%:p=0.55). The colorectal surgeons performed fewer APR's (20.7% vs. 27.6%), created fewer stomas (40.7% vs. 51.6%), had improved circumferential margin positivity rates (37.9% vs. 20.3%) and better nodal harvest rates (51.6% vs. 62.7%) in the third time frame compared to second.

Conclusion: The development of a colorectal service has improved the outcome of rectal cancer surgery.