Evolving Patterns Of Care For Operable Rectal Cancer In A Tertiary Teaching Hospital In The Last Three Years

Objective:By assessing the current pattern of care for operable rectal cancer in our hospital in the last three years, this study aims to discover the defects in clinical practice, improve the pattern and quality of care for rectal cancer and provide the baseline data for future clinical studies.Methods:The retrospective study obtained and analyzed data from records of patients operated for rectal cancer in our hospital during from2010to2012. According to NCCN Clinical Practice Guidelines in Oncology for Rectal Cancer during that time and Diagnosis and Treatment Standards for Colorectal Cancer (2010edition) from the Chinese Ministry of Health, the questionnaires were designed to record patient characteristics, preoperative examinations, pathologic features, treatment options, follow-up and therapeutic effect. Frequencies and corresponding percentages were calculated to describe the evolution for patterns of care for operable rectal cancer during these years.Results:In our hospital, the main preoperative examinations for rectal cancer include tumor markers detection,64-row CT and electronic colonoscopy and biopsy. Colonoscopy with biopsy was the most frequent examination, the rate of biopsy increased sharply in the last two years. The ratio of tumor marker examination was around80%and CT examination above90%, but the proportion of joint chest-abdominal-pelvic CT scan is rising rapidly year by year; rigid proctoscopy endoscopic ultrasound and pelvic MRI were routine preoperative examination in our hospital. For operable rectal cancer the curative resection rate was94.9%from2010to2012. The ration of laparoscopic surgery was39.2%, especially in2012, laparoscopic surgery increased compared with before. The study shows that in our hospital, pathological examination and reporting still need to be improved, but in the last three years, the number of lymph node from radical operations was rising rapidly year by year and the great rise in2012was very obvious. The proportion of reports that describe vascular and nerve infiltration situation increased rapidly. Perioperative treatments choices and modalities are improving. In2012that ratio of rectal cancer patients receiving perioperative adjuvant therapy was significantly higher than usual, with postoperative adjuvant chemotherapy is of priority and "CapeOx" was our conventional chemotherapy regimens. Nearly half of the patients regularly examined tumor makers(CEA and CA19-9) and CT scans after discharged and only17.1%of patients received postoperative endoscopic examination. Most patients didn’t pay due attention to check-ups, for follow-up after discharged. Interventional treatment for advanced rectal cancer patients is increasing in our hospital. In recent years, radiofrequency ablation has becoming a common modality for liver metastases, though its efficacy needs further research.Conclusion:This study reflects the pattern of care for rectal cancer in a tertiary teaching hospital of the developed areas in China. To some extent, it can reflect the current state of care for rectal cancer in the region. Compared with requirements of available guidelines and standards, there is still room for improvement in the care of rectal cancer. But the good news is, benefited from the multi-disciplinary co-operation, the pattern of care for rectal cancer is evolving rapidly to meet the requirements of international and national standards.