RESEARCH. The cluster-randomized Quality Initiative in Rectal Cancer trial: evaluating a quality-improvement strategy in surgery

Simunovic, Marko; Coates, Angela; Goldsmith, Charles H.; Thabane, Lehana; Reeson, Dana; Smith, Andrew; McLeod, Robin S.; DeNardi, Franco; Whelan, Timothy J.; Levine, Mark N.
September 2010
CMAJ: Canadian Medical Association Journal;9/7/2010, Vol. 182 Issue 12, p1301
Academic Journal
Background: Following surgery for rectal cancer, two unfortunate outcomes for patients are permanent colostomy and local recurrence of cancer. We tested whether a quality-improvement strategy to change surgical practice would improve these outcomes. Methods: Sixteen hospitals were cluster-randomized to the intervention (Quality Initiative in Rectal Cancer strategy) or control (normal practice) arm. Consecutive patients with primary rectal cancer were accrued from May 2002 to December 2004. Surgeons at hospitals in the intervention arm could voluntarily participate by attending workshops, using opinion leaders, inviting a study team surgeon to demonstrate optimal techniques of total mesorectal excision, completing postoperative questionnaires, and receiving audits and feedback. Main outcome measures were hospital rates of permanent colostomy and local recurrence of cancer. Results: A total of 56 surgeons (n = 558 patients) participated in the intervention arm and 49 surgeons (n = 457 patients) in the control arm. The median follow-up of patients was 3.6 years. In the intervention arm, 70% of surgeons participated in workshops, 70% in intraoperative demonstrations and 71% in postoperative questionnaires. Surgeons who had an intraoperative demonstration provided care to 86% of the patients in the intervention arm. The rates of permanent colostomy were 39% in the intervention arm and 41% in the control arm (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.63-1.48). The rates of local recurrence were 7% in the intervention arm and 6% in the control arm (OR 1.06, 95% CI 0.68-1.64). Interpretation: Despite good participation by surgeons, the resource-intense quality-improvement strategy did not reduce hospital rates of permanent colostomy or local recurrence compared with usual practice. (ClinicalTrials.gov trial register no. NCT00182130.)


Related Articles

  • Local recurrence following rectal resection for cancer. Eu, K.-W.; Seow-Choen, F.; Ho, J.M.S.; Ho, Y.H.; Leong, A.F.P.K. // Journal of the Royal College of Surgeons of Edinburgh;Dec98, Vol. 43 Issue 6, p393 

    Examines departmental results following rectal cancer surgery to determine local recurrence rates. Poor prognosis in recurrent rectal carcinoma following surgery; Incidence of local recurrence; Suggested treatment of rectal cancer by surgeons with special interest and training.

  • Predictors of Successful Salvage Surgery for Local Pelvic Recurrence of Rectosigmoid Colon and Rectal Cancers. Akihiko Kobayashi; Masanori Sugito; Masaaki Ito; Norio Saito // Surgery Today;Oct2007, Vol. 37 Issue 10, p853 

    Abstract Purpose  We investigated the predictors of successful resection of recurrent tumors and improved survival in patients with local pelvic recurrence of rectosigmoid colon and rectal cancer. Methods  We analyzed the clinicopathological factors of 94 patients who underwent...

  • Palliation of carcinoma of the rectum using the urologic resectoscope. Hamy, A.; Tuech, J.-J.; Pessaux, P.; Regenet, N.; Ziani, M.; Bergamaschi, R.; Arnaud, J.-P. // Surgical Endoscopy;Apr2003, Vol. 17 Issue 4, p627 

    Background: Thirty percent to 40% of patients with rectal cancer are not candidates for aggressive surgery because of distant metastases, extensive local tumor infiltration, poor general condition, or refusal of the patient. The aim of this study was to report the results of endoscopic transanal...

  • Results from an American Society of Colon and Rectal Surgeons survey on the management of young-onset colorectal cancer. Warrier, S.; Kalady, M.; Kiran, R.; Church, J. // Techniques in Coloproctology;Mar2014, Vol. 18 Issue 3, p265 

    Background: Young patients with colorectal cancer (CRC) present a diagnostic and clinical challenge. The aim of our study was to survey the approaches to preoperative evaluation and clinical management of young patients with CRC by colorectal surgeons in North America. Methods: A standard...

  • Retrospective review of rectal cancer surgery in northern Alberta. Pelletier, Jean-Sébastien; DeGara, Christopher; Porter, Geoff; Ghosh, Sunita; Schiller, Dan // Canadian Journal of Surgery;Aug2013, Vol. 56 Issue 4, pE51 

    Introduction: Previous studies, including research published more than 10 years ago in Northern Alberta, have demonstrated improved outcomes with increased surgical volume and subspecialisation in the treatment of rectal cancer. We sought to examine contemporary rectal cancer care in the same...

  • A Prospective Single-Institution Evaluation of Current Practices of Early Postoperative Feeding after Elective Intestinal Surgery. Rohatiner, Tamar; Wend, Joseph; Rhodes, Samuel; Murrell, Zuri; Berel, Dror; Fleshner, Phillip // American Surgeon;Oct2012, Vol. 78 Issue 10, p1147 

    Postoperative diet advancement in patients undergoing elective small bowel or colorectal surgery by general surgeons (GSs) and colorectal surgeons (CRSs) was prospectively evaluated. Demographic (age and gender), disease location (small bowel or colorectum), surgical approach flaparoscopic or...

  • Colorectal surgery as a specialty. Goligher, John // Journal of the Royal Society of Medicine;Nov1996, Vol. 89 Issue 11, p601 

    The article examines the issue on whether colorectal surgery should be practiced by specialists or by general surgeons. It is pointed out that a general surgeon who starts to perform mostly colorectal surgeries will eventually find himself practicing little else. The issue cannot be resolved at...

  • COLON AND RECTAL SURGERY.  // New York;6/14/2004, Vol. 37 Issue 21, p56 

    Presents information about the top colon and rectal surgeons in New York. Specialization; Contact information.

  • Guidelines 2000 for Colon and Rectal Cancer Surgery. Nelson, Heidi; Petrelli, Nicholas; Carlin, Arthur; Couture, Jean; Fleshman, James; Guillem, Jose; Miedema, Brent; Ota, David; Sargent, Daniel // JNCI: Journal of the National Cancer Institute;04/18/2001, Vol. 93 Issue 8, p583 

    Presents guidelines that provide uniform definitions, principles and practices for colon and rectal cancer surgery, drafted by a panel sponsored by the National Cancer Institute. Anatomic definitions; Ideal bowel resection and margins; Surgical techniques for the rectum and colon; Surgical...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics