Reduction of postoperative morbidity and mortality in patients with rectal cancer following the introduction of a colorectal unit

Abstract

Background Surgery for rectal cancer is associated with high morbidity and mortality rates. The reason for this has been much debated. This population-based study reports the findings on postoperative morbidity and mortality after rectal cancer surgery following the introduction of a centralized colorectal unit in a county central hospital, supervised by a colorectal surgeon using the most recent techniques. Methods All consecutive patients with rectal cancer who underwent surgery at four county hospitals in the Västmanland county in Sweden during 1993–1996 (n = 133) were compared with patients who underwent surgery at the new colorectal unit in the county central hospital from 1996 to 1999 (n = 144). Results The number of operating surgeons was reduced from 26 to four. The postoperative mortality rate decreased from 8 to 1 per cent (P = 0·002) and the total postoperative complication rate was reduced from 57 to 24 per cent (P < 0·001). Surgical complications dropped from 37 to 11 per cent (P < 0·001). The relaparotomy rate fell from 11 to 4 per cent (P < 0·05). Postoperative stay in hospital was reduced from a median of 13 to 9 days (P < 0·001). Conclusion The new organization, with centralized rectal cancer surgery using modern techniques, reduced postoperative mortality and overall morbidity rates to less than half.