Association of certification, improved quality and better oncological outcomes for rectal cancer in a specialized colorectal unit

• Published in: International journal of colorectal disease 2021-03, Vol.36 (3), p.517-533
• Main Authors: Jacob, Annika, Albert, Wolfgang, Jackisch, Thomas, Jakob, Christiane, Sims, Anja, Witzigmann, Helmut, Mees, Sören Torge, Stelzner, Sigmar
• Format: Article
• Language: English
• Subjects: Analysis; Anastomotic leak; Cancer; Cancer patients; Care and treatment; Certification; Colorectal cancer; Gastroenterology; Hepatology; Internal Medicine; Medical care; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Original Article; Patient outcomes; Proctology; Quality control; Quality management; Rectum; Surgery
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-020-03792-8

Purpose Centralization of cancer care is expected to yield superior results. In Germany, the national strategy is based on a voluntary certification process. The effect of centre certification is difficult to prove because quality data are rarely available prior to certification. This observational study aims to assess outcomes for rectal cancer patients before and after implementation of a certified cancer centre. Patients and methods All consecutive patients treated for rectal cancer in our certified centre from 2009 to 2017 were retrieved from a prospective database. The dataset was analyzed according to a predefined set of 19 quality indicators comprising 36 quality goals. The results were compared to an identical cohort of patients, treated from 2000 to 2008 just before centre implementation. Results In total, 1059 patients were included, 481 in the 2009–2017 interval and 578 in the 2000–2008 interval. From 2009 to 2017, 25 of 36 quality goals were achieved (vs. 19/36). The proportion of anastomotic leaks in low anastomoses was improved (13.5% vs. 22.1%, p = 0.018), as was the local 5-year recurrence rate for stage (y)pIII rectal cancers (7.7% vs. 17.8%, p = 0.085), and quality of mesorectal excision (0.3% incomplete resections vs. 5.5%, p = 0.002). Furthermore, a decrease of abdominoperineal excisions was noted (47.1% vs. 60.0%, p = 0.037). For the 2009–2017 interval, local 5-year recurrence rate in stages (y)p0-III was 4.6% and 5-year overall survival was 80.2%. Conclusions Certification as specialized centre and regular audits were associated with an improvement of various quality parameters. The formal certification process has the potential to enhance quality of care for rectal cancer patients.