Colorectal surgery in a rural setting

Colorectal surgery is increasingly being concentrated in high-volume tertiary centers, whereas it has been demonstrated that it can be performed safely and effectively even in low-volume hospitals. We analyzed data of patients who underwent major colorectal surgery in 1 year in a "rural" hospital, located on a small island, where a dynamic colorectal multidisciplinary team (MDT) and an enhanced recovery programme have been implemented. Primary endpoints were rate of laparoscopic resections, morbidity, mortality and number of lymph nodes retrieved and examined. Secondary endpoints were rate of R0 resections and length of postoperative stay. Seventy-six patients had surgery for a severe colorectal condition. Fifty-five resections have been performed, 38 by laparoscopy (69.1 %). Conversion rate was 5 %. Morbidity for resections was 21.8 %. General leak rate was 1.8 %, no leaks in laparoscopic resections. There was no difference in morbidity between open and laparoscopic resections. Postoperative stay was significantly shorter in laparoscopic vs open operations and in elective vs emergency operations. Number of lymph nodes retrieved was higher in laparoscopic vs open resections, 85.4 % of patients had 12 or more lymph nodes examined. Overall rate of R0 resections was 80.5 %, higher in laparoscopic vs open resections. Major colorectal surgery can be performed safely and effectively also in low-volume hospitals in the presence of a trained high-volume surgeon, an effective MDT and an Enhanced Recovery Programme.