[Indicators of quality in surgical treatment of rectal carcinoma]

For the assessment of surgical therapy for rectal cancer, perioperative and oncological as well as aspects of quality of life have to be taken into consideration. The objective of the present analysis was to identify indicators allowing assessment of the quality of the surgical intervention.

Between March 1997 and August 1998,50 patients with adenocarcinoma of the rectum were operated on by five surgeons according to the concept of total or partial mesorectal excision. In 4 patients an anterior, in 35 a low anterior resection, and in 11 an abdominoperineal resection was performed. There was a stage IV (UICC) present in 9 cases, and in 18 patients the tumor extension was restricted to the wall. The demographic and perioperative data as well as the results of the follow-up examination were registered prospectively. The median follow-up period amounted to 44 months (5-57).

Intraoperative parameters showed no differences concerning the individual operating surgeons. General complications arose in 9 (50%) and surgical complications in 34 (68%) patients. Anastomotic leakage (5/39), perineal wound infection, and bladder dysfunction (requiring catheterization for bladder emptying) occurred as frequent complications and there were differences with regard to the surgeon. The rate of local recurrence was different and was between 0% and 75% for the individual surgeons.

For the assessment of surgery for rectal carcinoma, only a few parameters are necessary. As indicators of quality after rectal resection, the rate of anastomotic leakage should be registered; after abdominoperineal resection, the rate of perineal wound infection, the ratio of postoperative bladder dysfunction, and the locoregional rate of recurrence should be registered.