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The Vermont colorectal cancer project: self-portrait
1Department of Surgery, University of Vermont, Fletcher House 301, 111 Colchester Ave, Burlington, VT 05401, USA. Neil.Hyman@vtmednet.org
Hypothesis:
A prospective statewide quality assessment and improvement project requiring active participation and case entry by surgeons is feasible provided that confidentiality and peer review protection are provided.
Design:
Inception cohort.
Setting:
Acute-care hospitals in Vermont.
Patients:
Consecutive series of 364 patients undergoing elective surgery for colorectal cancer between April 1, 1999, and March 31, 2001, who were prospectively entered into a database created by the Vermont Chapter of the American College of Surgeons under peer review protection from the Vermont Program for Quality Health Care.
Intervention:
Surgery for invasive colorectal cancer.
Main Outcome Measures:
Case entry compliance, surgical complications, length of stay, demographics, cancer-specific characteristics, and use of adjuvant therapy.
Results:
The calculated case entry compliance rate was 78%. There were 7 deaths (2%) and 45 major complications in 39 patients (12.3%). All patients were offered referral for adjuvant therapy when appropriate based on National Institutes of Health Consensus Conference standards. Mean age was 68.7 years, and 52% of cancers occurred in women. The most common site of cancer was the right colon (36.6% of patients), and only 47.9% of malignancies were in the rectum or sigmoid. Eighty-two percent of patients had symptoms on presentation.
Conclusions:
Elective colorectal cancer surgery in Vermont is reasonably safe, and adherence to national standards for the use of adjuvant therapy is outstanding. Surgeons will provide outcome data if confidentiality and peer review protection are provided. The predominance of right-sided lesions and the low incidence of asymptomatic detection have significant implications for screening efforts in Vermont.