Skip to main content

Advertisement

SpringerLink
Log in

Prospective multicenter registration study of colorectal cancer: significant variations in radicality and oncosurgical quality—Swiss Group for Clinical Cancer Research Protocol SAKK 40/00

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to investigate in a multicenter cohort study the radicality of colorectal cancer resections, to assess the oncosurgical quality of colorectal specimens, and to compare the performance between centers.

Methods

One German and nine Swiss hospitals agreed to prospectively register all patients with primary colorectal cancer resected between September 2001 and June 2005. The median number of eligible patients with one primary tumor included per center was 95 (range 12–204).

Results

The following variations of median values or percentages between centers were found: length of bowel specimen 20–39 cm (25.8 cm), maximum height of mesocolon 6.5–12.5 cm (9.0 cm), number of examined lymph nodes 9–24 (16), distance to nearer bowel resection margin in colon cancer 4.8–12 cm (7 cm), and in rectal cancer 2–3 cm (2.5 cm), central ligation of major artery 40–97 % (71 %), blood loss 200–500 ml (300 ml), need for perioperative blood transfusion 5–40 % (19 %), tumor opened during mobilization 0–11 % (5 %), T4-tumors not en-bloc resected 0–33 % (4 %), inadvertent perforation of mesocolon/mesorectum 0–8 % (4 %), no-touch isolation technique 36–86 % (67 %), abdominoperineal resection for rectal cancer 0–30 % (17 %), rectal cancer specimen with circumferential margin ≤1 mm 0–19 % (10 %), in-hospital mortality 0–6 % (2 %), anastomotic leak or intra-abdominal abscess 0–17 % (7 %), re-operation 0–17 % (8 %).

Conclusion

In colorectal cancer, surgery considerable variations between different centers were found with regard to radicality and oncosurgical quality, suggesting a potential for targeted improvement of surgical technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Renzulli P, Lowy A, Maibach R, Egeli RA, Metzger U, Laffer UT (2006) The influence of the surgeon’s and the hospital’s caseload on survival and local recurrence after colorectal cancer surgery. Surgery 139(3):296–304

    Article  PubMed  Google Scholar 

  2. Dorrance HR, Docherty GM, O’Dwyer PJ (2000) Effect of surgeon specialty interest on patient outcome after potentially curative colorectal cancer surgery. Dis Colon rectum 43(4):492–498

  3. Iversen LH, Harling H, Laurberg S, Wille-Jorgensen P, Danish Colorectal Cancer G (2007) Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence. Part 2: long-term outcome. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland 9(1):38–46

    Article  CAS  Google Scholar 

  4. Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP (1984) Local recurrence following ‘curative’ surgery for large bowel cancer: I. The overall picture. The British journal of surgery 71(1):12–16

    Article  CAS  PubMed  Google Scholar 

  5. Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP (1984) Local recurrence following ‘curative’ surgery for large bowel cancer: II. The rectum and rectosigmoid. The British journal of surgery 71(1):17–20

    Article  CAS  PubMed  Google Scholar 

  6. McArdle CS, Hole D (1991) Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival. BMJ 302(6791):1501–1505

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Porter GA, Soskolne CL, Yakimets WW, Newman SC (1998) Surgeon-related factors and outcome in rectal cancer. Ann Surg 227(2):157–167

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Borowski DW, Kelly SB, Bradburn DM, Wilson RG, Gunn A, Ratcliffe AA, Northern Region Colorectal Cancer Audit G (2007) Impact of surgeon volume and specialization on short-term outcomes in colorectal cancer surgery. The British journal of surgery 94(7):880–889

    Article  CAS  PubMed  Google Scholar 

  9. Iversen LH, Harling H, Laurberg S, Wille-Jorgensen P (2007) Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence. Part 1: short-term outcome. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland 9(1):28–37

    Article  CAS  Google Scholar 

  10. Association of Coloproctology of Great Britain and Ireland (2007) Guidelines for the management of colorectal cancer. 3rd edn.

  11. Otchy D, Hyman NH, Simmang C, Anthony T, Buie WD, Cataldo P, Church J, Cohen J, Dentsman F, Ellis CN, Kilkenny JW III, Ko C, Moore R, Orsay C, Place R, Rafferty J, Rakinic J, Savoca P, Tjandra J, Whiteford M, Standards Practice Task F, American Society of C, Rectal S (2004) Practice parameters for colon cancer. Dis Colon rectum 47(8):1269–1284

    Article  PubMed  Google Scholar 

  12. Tjandra JJ, Kilkenny JW, Buie WD, Hyman N, Simmang C, Anthony T, Orsay C, Church J, Otchy D, Cohen J, Place R, Denstman F, Rakinic J, Moore R, Whiteford M, Standards Practice Task F, American Society of C, Rectal S (2005) Practice parameters for the management of rectal cancer (revised). Dis Colon rectum 48(3):411–423

    Article  PubMed  Google Scholar 

  13. Schmiegel W, Reinacher-Schick A, Arnold D, Graeven U, Heinemann V, Porschen R, Riemann J, Rodel C, Sauer R, Wieser M, Schmitt W, Schmoll HJ, Seufferlein T, Kopp I, Pox C (2008) Update S3-guideline “colorectal cancer” 2008. Zeitschrift fur Gastroenterologie 46(8):799–840

    Article  CAS  PubMed  Google Scholar 

  14. Maurer CA (2004) Colon cancer: resection standards. Techniques in coloproctology 8(Suppl 1):s29–s32

    Article  PubMed  Google Scholar 

  15. Maurer CA, Renzulli P, Meyer JD, Buchler MW (1999) Rectal carcinoma. Optimizing therapy by partial or total mesorectum removal. Zentralblatt fur Chirurgie 124(5):428–435

    CAS  PubMed  Google Scholar 

  16. Sobin LHWC UICC International Union Against Cancer TNM classification of malignant tumours, 6th edn. Wiley, Lissabon, New York

  17. Turnbull RB Jr, Kyle K, Watson FR, Spratt J (1967) Cancer of the colon: the influence of the no-touch isolation technic on survival rates. Ann Surg 166(3):420–427

    Article  PubMed  PubMed Central  Google Scholar 

  18. Goldstein NS, Soman A, Sacksner J (1999) Disparate surgical margin lengths of colorectal resection specimens between in vivo and in vitro measurements. The effects of surgical resection and formalin fixation on organ shrinkage. Am J Clin Pathol 111(3):349–351

    Article  CAS  PubMed  Google Scholar 

  19. Kwok SP, Lau WY, Leung KL, Liew CT, Li AK (1996) Prospective analysis of the distal margin of clearance in anterior resection for rectal carcinoma. The British journal of surgery 83(7):969–972

    Article  CAS  PubMed  Google Scholar 

  20. Weese JL, O’Grady MG, Ottery FD (1986) How long is the five centimeter margin? Surgery, gynecology & obstetrics 163(2):101–103

    CAS  Google Scholar 

  21. Neufeld D, Bugyev N, Grankin M, Gutman M, Klein E, Bernheim J, Shpitz B (2007) Specimen length as a perioperative surrogate marker for adequate lymphadenectomy in colon cancer: the surgeon's role. Int Surg 92(3):155–160

    PubMed  Google Scholar 

  22. Wang J, Kulaylat M, Rockette H, Hassett J, Rajput A, Dunn KB, Dayton M (2009) Should total number of lymph nodes be used as a quality of care measure for stage III colon cancer? Ann Surg 249(4):559–563

    Article  PubMed  Google Scholar 

  23. Le Voyer TE, Sigurdson ER, Hanlon AL, Mayer RJ, Macdonald JS, Catalano PJ, Haller DG (2003) Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 21(15):2912–2919

    Article  CAS  Google Scholar 

  24. Chen SL, Bilchik AJ (2006) More extensive nodal dissection improves survival for stages I to III of colon cancer: a population-based study. Ann Surg 244(4):602–610

    PubMed  PubMed Central  Google Scholar 

  25. van Steenbergen LN, van Lijnschoten G, Rutten HJ, Lemmens VE, Coebergh JW (2010) Improving lymph node detection in colon cancer in community hospitals and their pathology department in southern Netherlands. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 36(2):135–140

    Article  Google Scholar 

  26. Wright FC, Law CH, Last L, Khalifa M, Arnaout A, Naseer Z, Klar N, Gallinger S, Smith AJ (2003) Lymph node retrieval and assessment in stage II colorectal cancer: a population-based study. Ann Surg Oncol 10(8):903–909

    Article  CAS  PubMed  Google Scholar 

  27. Rosenberg R, Friederichs J, Schuster T, Gertler R, Maak M, Becker K, Grebner A, Ulm K, Hofler H, Nekarda H, Siewert JR (2008) Prognosis of patients with colorectal cancer is associated with lymph node ratio: a single-center analysis of 3,026 patients over a 25-year time period. Ann Surg 248(6):968–978

    Article  PubMed  Google Scholar 

  28. Berger AC, Sigurdson ER, LeVoyer T, Hanlon A, Mayer RJ, Macdonald JS, Catalano PJ, Haller DG (2005) Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 23(34):8706–8712

    Article  Google Scholar 

  29. Peschaud F, Benoist S, Julie C, Beauchet A, Penna C, Rougier P, Nordlinger B (2008) The ratio of metastatic to examined lymph nodes is a powerful independent prognostic factor in rectal cancer. Ann Surg 248(6):1067–1073

    Article  PubMed  Google Scholar 

  30. Vaccaro CA, Im V, Rossi GL, Quintana GO, Benati ML, Perez de Arenaza D, Bonadeo FA (2009) Lymph node ratio as prognosis factor for colon cancer treated by colorectal surgeons. Dis Colon rectum 52(7):1244–1250

    Article  PubMed  Google Scholar 

  31. Hida J, Okuno K, Yasutomi M, Yoshifuji T, Uchida T, Tokoro T, Shiozaki H (2005) Optimal ligation level of the primary feeding artery and bowel resection margin in colon cancer surgery: the influence of the site of the primary feeding artery. Dis Colon rectum 48(12):2232–2237

    Article  PubMed  Google Scholar 

  32. West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P (2008) Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. The lancet oncology 9(9):857–865

    Article  PubMed  Google Scholar 

  33. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation-technical notes and outcome. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland 11(4):354–364

    Article  CAS  Google Scholar 

  34. Read TE, Mutch MG, Chang BW, McNevin MS, Fleshman JW, Birnbaum EH, Fry RD, Caushaj PF, Kodner IJ (2002) Locoregional recurrence and survival after curative resection of adenocarcinoma of the colon. J Am Coll Surg 195(1):33–40

    Article  PubMed  Google Scholar 

  35. Slanetz CA Jr, Grimson R (1997) Effect of high and intermediate ligation on survival and recurrence rates following curative resection of colorectal cancer. Dis Colon rectum 40(10):1205–1218

    Article  PubMed  Google Scholar 

  36. Toyota S, Ohta H, Anazawa S (1995) Rationale for extent of lymph node dissection for right colon cancer. Dis Colon rectum 38(7):705–711

    Article  CAS  PubMed  Google Scholar 

  37. Morikawa E, Yasutomi M, Shindou K, Matsuda T, Mori N, Hida J, Kubo R, Kitaoka M, Nakamura M, Fujimoto K et al (1994) Distribution of metastatic lymph nodes in colorectal cancer by the modified clearing method. Dis Colon rectum 37(3):219–223

    Article  CAS  PubMed  Google Scholar 

  38. Busch OR, Hop WC, Hoynck van Papendrecht MA, Marquet RL, Jeekel J (1993) Blood transfusions and prognosis in colorectal cancer. N Engl J Med 328(19):1372–1376

    Article  CAS  PubMed  Google Scholar 

  39. Morris E, Quirke P, Thomas JD, Fairley L, Cottier B, Forman D (2008) Unacceptable variation in abdominoperineal excision rates for rectal cancer: time to intervene? Gut 57(12):1690–1697

    Article  CAS  PubMed  Google Scholar 

  40. Zirngibl H, Husemann B, Hermanek P (1990) Intraoperative spillage of tumor cells in surgery for rectal cancer. Dis Colon rectum 33(7):610–614

    Article  CAS  PubMed  Google Scholar 

  41. Slanetz CA Jr (1984) The effect of inadvertent intraoperative perforation on survival and recurrence in colorectal cancer. Dis Colon rectum 27(12):792–797

    Article  PubMed  Google Scholar 

  42. Eriksen MT, Wibe A, Syse A, Haffner J, Wiig JN, Norwegian Rectal Cancer G, Norwegian Gastrointestinal Cancer G (2004) Inadvertent perforation during rectal cancer resection in Norway. The British journal of surgery 91(2):210–216

    Article  CAS  PubMed  Google Scholar 

  43. Maurer CA, Renzulli P, Kull C, Kaser SA, Mazzucchelli L, Ulrich A, Buchler MW (2011) The impact of the introduction of total mesorectal excision on local recurrence rate and survival in rectal cancer: long-term results. Ann Surg Oncol 18(7):1899–1906

    Article  CAS  PubMed  Google Scholar 

  44. Maurer CA (2005) Urinary and sexual function after total mesorectal excision. Recent results in cancer research Fortschritte der Krebsforschung Progres dans les recherches sur le cancer 165:196–204

    PubMed  Google Scholar 

  45. Maurer CA, Z'Graggen K, Renzulli P, Schilling MK, Netzer P, Buchler MW (2001) Total mesorectal excision preserves male genital function compared with conventional rectal cancer surgery. The British journal of surgery 88(11):1501–1505

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the co-workers of the pathology institutes of Liestal, Chur, Bern, Zürich, Luzern, all in Switzerland, and of Homburg-Saar, Germany, for their excellent collaboration in examination of all the colorectal specimens in a standardized manner and in completing the pathology forms. Furthermore, we thank Mr. Michael Mayer and Mrs. Hong Sun for the statistical support and Mrs. E. Hansen and L. Kacina for data collection, all from the SAKK Coordinating Center in Bern. The study was financially supported by the Swiss State Secretariat for Education and Research (SER).

Author information

Authors and Affiliations

  1. Departments of Surgery of Hospital of Liestal, Liestal, Switzerland

    Christoph A. Maurer & Katharina Kessler

  2. Hirslanden Group, Clinic Beau-Site, Schänzlihalde 11, 3000, Bern, Switzerland

    Christoph A. Maurer

  3. Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland

    Daniel Dietrich & Peter Brauchli

  4. University Hospital of Homburg/Saar (DE), Homburg, Germany

    Martin K. Schilling

  5. Triemli Hospital of Zürich, Zürich, Switzerland

    Urs Metzger

  6. Hospital of Biel, Biel, Switzerland

    Urban Laffer

  7. Waid Hospital of Zürich, Zürich, Switzerland

    Peter Buchmann

  8. Hospital of Zug, Zug, Switzerland

    Bruno Lerf

  9. Hospital of of Chur, Chur, Switzerland

    Peter Villiger

  10. Hospital of of Uster, Uster, Switzerland

    Gian Melcher

  11. Hospital of of Aarberg, Aarberg, Switzerland

    Christian Klaiber

  12. Hospital of Ilanz, Ilanz, Switzerland

    Christian Bilat

  13. Institute of Pathology, University of Basel, Basel, Switzerland

    Luigi Terracciano

Authors
  1. Christoph A. Maurer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel Dietrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin K. Schilling
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Urs Metzger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Urban Laffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter Buchmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bruno Lerf
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Peter Villiger
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gian Melcher
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Christian Klaiber
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Christian Bilat
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Peter Brauchli
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Luigi Terracciano
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Katharina Kessler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christoph A. Maurer.

Additional information

Christian Klaiber is deceased October 2013

Appendix

Appendix

Table 5 Patient and tumor characteristics, analyzed as overall statistics and per each surgical department
Full size table
Table 6 Results regarding surgical radicality, analyzed as overall statistics and per each surgical department
Full size table
Table 7 Results regarding oncosurgical quality, analyzed as overall statistics and per each surgical department
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maurer, C.A., Dietrich, D., Schilling, M.K. et al. Prospective multicenter registration study of colorectal cancer: significant variations in radicality and oncosurgical quality—Swiss Group for Clinical Cancer Research Protocol SAKK 40/00. Int J Colorectal Dis 32, 57–74 (2017). https://doi.org/10.1007/s00384-016-2667-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-016-2667-6

Keywords

Search

Navigation