Effect of a surgical training programme on outcome of rectal cancer in theCounty of Stockholm

Background The Stockholm I and II randomised trials demonstrated the value of preoperative radiotherapy in preventing local recurrence in rectal cance r. This study investigated the potential for further improvement by introdu ction of the concept of total mesorectal excision (TME) to surgeons in Stoc kholm, Sweden. Methods Workshops started in 1994 and included 11 television-based demonstr ations and two histopathology sessions. The study population consisted of a ll patients who underwent abdominal operations for rectal cancer in Stockho lm County during 1995-96 (TME project; n=447). Outcomes at 2 years were com pared with those from the Stockholm I (n=790) and 11 (n=542) trials as hist orical controls. Findings For patients with curative abdominal resections, there were no dif ferences between the Stockholm 1 (n=686), Stockholm II (n=481), and TME pro ject (n=381) groups in 30-day mortality (30 [4%], six [1%], and 12 [3%]), a nastomotic leakage (27 [10%], 18 [9%], and 23 [9%]), or all complications ( 204 [30%], 169 [35%], and 134 [35%]). This similarity was achieved despite a decrease in the proportion of abdominoperineal procedures from 55-60% to 27%. Local recurrence occurred in significantly fewer of the TME group than of the Stockholm I and II groups (21 [6%] vs 103 [15%] and 66 [14%], p<0.0 01) as did cancer-related death (35 [9%] vs 104 [15%] and 77 [16%], p<0.002 ). Interpretation A surgical teaching initiative had a major effect on cancer outcomes. The proportion of abdominoperineal procedures and the local recur rence rate decreased by more than 50% and there is already evidence of a de cline in rectal-cancer mortality.