COLORECTAL RESECTION IN PERIPHERAL NEW ZEALAND: WORKLOAD, OUTCOMES AND ITS FUTURE

Abstract

Published Australasian findings on colorectal cancer surgery workload and performance outcomes have been predominantly from urban specialist units. This study defines workload and index markers of surgical quality for colorectal resections carried out in a peripheral teaching hospital of New Zealand. All cases of colorectal cancer surgery between 1 June 1997 and 31 May 2000 were included. One hundred and ninety-one colorectal resections for 197 colorectal carcinomas were carried out. Sites of carcinoma were as follows: 57 rectal (29%), 59 sigmoid (30%), 34 descending/transverse (17%) and 47 ascending/caecal (24%). Advanced pathological stage (Dukes' C or metastatic) was diagnosed in 55%. Performance outcome variables for anterior resections were as follows: wound infection, 14%; anastomotic leak rate, 10.5%; local recurrence within 2-5 years, 14%; unplanned reoperation within 30 days, 16%; and perioperative mortality, 3.5%. Performance outcomes for all other colorectal cancer resections were as follows: wound infection, 10%; no anastomotic leaks; local recurrence, 2%; unplanned reoperation, 4%; and mortality, 4.5%. Workload and performance outcomes of colorectal cancer resection in provincial New Zealand have been defined in this study. A high proportion of patients presenting to Southland Hospital had advanced cancer in the rectum or distal colon. The main clinical indicators of colorectal cancer surgery outcome (mortality, anastomotic leak, wound infection and local recurrence) compare favourably with accepted standards of the time. Workload is adequate to maintain such outcomes. Future colorectal surgery in non-specialized units is important and can achieve good results.