@article{606e4cdbc93b4e4fb091e941e3ccaeac,
title = "International evaluation of circumferential resection margins after rectal cancer resection: insights from the Swedish and Dutch audits",
abstract = "Aim This study aimed to determine predictive factors for the circumferential resection margin (CRM) within two northern European countries with supposed similarity in providing rectal cancer care. Method Data for all patients undergoing rectal resection for clinical tumour node metastasis (TNM) stage I-III rectal cancer were extracted from the Swedish ColoRectal Cancer Registry and the Dutch ColoRectal Audit (2011-2015). Separate analyses were performed for cT1-3 and cT4 stage. Predictive factors for the CRM were determined using univariable and multivariable logistic regression analyses. Results A total of 6444 Swedish and 12 089 Dutch patients were analysed. Over time the number of hospitals treating rectal cancer decreased from 52 to 42 in Sweden, and 82 to 79 in the Netherlands. In the Swedish population, proportions of cT4 stage (17% vs 8%), multivisceral resection (14% vs 7%) and abdominoperineal excision (APR) (37% vs 31%) were higher. The overall proportion of patients with a positive CRM (CRM+) was 7.8% in Sweden and 5.4% in the Netherlands. In both populations with cT1-3 stage disease, common independent risk factors for CRM+ were cT3, APR and multivisceral resection. No common risk factors for CRM+ in cT4 stage disease were found. An independent impact of hospital volume on CRM+ could be demonstrated for the cT1-3 Dutch population. Conclusion Within two northern European countries with implemented clinical auditing, rectal cancer care might potentially be improved by further optimizing the treatment of distal and locally advanced rectal cancer.",
keywords = "Rectal neoplasms, hospitals, surgical margin, colorectal surgery, Sweden, Netherlands, TOTAL MESORECTAL EXCISION, EXTRALEVATOR ABDOMINOPERINEAL EXCISION, PREOPERATIVE RADIOTHERAPY, COLORECTAL-CANCER, SURVIVAL, SURGERY, EPIDEMIOLOGY, INVOLVEMENT, STATEMENT, EUROPE",
author = "R. Detering and D. Saraste and Babberich, {M. P. M. de Neree Tot} and Dekker, {J. W. T.} and Wouters, {M. W. J. M.} and {van Geloven}, {A. A. W.} and Bemelman, {W. A.} and Tanis, {P. J.} and A. Martling and M. Westerterp and Arend Aalbers and Regina Beets-Tan and {den Boer}, Frank and Stephanie Breukink and Coene, {Peter Paul} and Pascal Doornebosch and Hans Gelderblom and Tom Karsten and Michel Ledeboer and Eric Manusama and Corrie Marijnen and Iris Nagtegaal and Korn Peeters and Rob Tollenaar and {van de Velde}, Cock and Anja Wagner and {van Westreenen}, Erik and {Swedish ColoRectal Cancer Registry} and {Dutch ColoRectal Audit}",
note = "Funding Information: . No ethical approval or informed consent was required under Dutch law as decided by the Medical Ethical Committee, Amsterdam UMC, University of Amsterdam, The Netherlands. For the Swedish part, the study was approved by the Regional Ethics Committee of the Karolinska Institutet in Stockholm, Sweden. This study compared anonymized data on rectal cancer surgery from the two national population‐based databases. Data were extracted from both registries and merged for analysis based on mandatory key variables needed to calculate performance indicators. This study was conducted in accordance with the STROBE guidelines Funding Information: The authors would like to thank all surgeons, registrars, physician assistants and administrative nurses who registered all the patients in the SCRCR and DCRA. Collaborators: the collaborators of the DCRA are Arend Aalbers (Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam), Regina Beets-Tan (Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam), Frank den Boer (Zaans Medical Center, Zaandam), Stephanie Breukink (Maastricht University Medical Centre, Maastricht), Peter Paul Coene (Maasstad Hospital, Rotterdam), Pascal Doornebosch (IJselland Hospital, Rotterdam), Hans Gelderblom (Leiden University Medical Centre, Leiden), Tom Karsten (OLVG, Amsterdam), Michel Ledeboer (Deventer Hospital, Deventer), Eric Manusama and Corrie Marijnen (Leiden University Medical Centre, Leiden), Iris Nagtegaal (Radboud University Medical Center, Nijmegen), Koen Peeters (Leiden University Medical Centre, Leiden), Rob Tollenaar (Leiden University Medical Centre, Leiden), Cock van de Velde (Leiden University Medical Centre, Leiden), Anja Wagner (Erasmus Medical Centre, Rotterdam) and Erik van Westreenen (ISALA hospital, Zwolle). Funding: This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. Publisher Copyright: {\textcopyright} 2019 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.",
year = "2020",
month = apr,
doi = "10.1111/codi.14903",
language = "English",
volume = "22",
pages = "416--429",
journal = "Colorectal Disease",
issn = "1462-8910",
publisher = "Wiley",
number = "4",
}