INFLUENCE OF HOSPITAL-RELATED AND SURGEON-RELATED FACTORS ON OUTCOME AFTER TREATMENT OF RECTAL-CANCER WITH OR WITHOUT PREOPERATIVE RADIOTHERAPY

Background Preoperative radiotherapy reduces recurrence rates after su rgery for rectal cancer but other variables may also affect outcome. T he Stockholm Rectal Cancer Study Group has conducted two prospective r andomized trials on preoperative radiotherapy in rectal cancer. Method s This study analysed postoperative morbidity and mortality, local rec urrence rate and death from rectal cancer in 1399 patients, according to different hospital- and surgeon-related factors. Results Patients o perated on by surgeons who were certified specialists for at least 10 years had a lower risk of local recurrence (relative risk 0.8 (95 per cent confidence interval (c.i.) 0.6-1.0)) and death from rectal cancer (relative risk 0.8 (95 per cent c.i. 0.7-0.9)). The risk was also low er for patients operated on in university hospitals (relative risk of local recurrence 0.7 (95 per cent c.i. 0.5-0.9), relative risk of deat h from rectal cancer 0.8 (95 per cent c.i. 0.7-1.0)) compared with com munity hospitals, although the results in some community hospitals wer e similar to those in university hospitals. The proportional reduction of local recurrence rate after preoperative radiotherapy was not sign ificantly different for the studied institutions and surgeons.Conclusi on There was a significant surgeon-related variation in patient outcom e, which is probably related to the surgical technique. Although impro ved technique may reduce the local recurrence rate, preoperative radio therapy is still beneficial concerning local control and survival.