Practice patterns and appropriateness of rectal cancer management in British Columbia

324 ABSTRACT: Survival and recurrence rates for all rectal cancers in BC in 1996 were suboptimal relative to reports from other centres. From chart reviews, questionnaire mail-outs, and telephone calls, we now report possible factors which could result in suboptimal outcomes, including suboptimal staging investigations, surgical procedures, and adjuvant radiation and chemotherapy. Staging investigations performed within 3 months of diagnosis were as follows: chest X-ray in 65% of patients, barium enema or colonoscopy in 74% of patients, CT scan in 21% of patients, ultrasound in 42% of patients, and endorectal ultrasound in 3% of patients. Adequacy of resection was judged by use of total mesorectal excision as the preferred surgical resection technique and by pathologic assessment of the radial resection margin. Whether total mesorectal excision was performed could not be reliably determined from operative reports. Radial resection margins were assessed in only 48% of pathology reports. Adjuvant radiation was given in 60% and adjuvant chemotherapy in 60% of stage 2 and stage 3 tumors. These data show that in BC there is suboptimal cancer staging by use of staging investigations and pathology reporting. Surgical techniques and use of adjuvant therapy are also suboptimal. As such, we have identified potential opportunities for improving outcome including improved use of staging investigations preoperatively, improved use of preoperative adjuvant radiation, postoperative adjuvant chemotherapy, and improved surgical techniques and pathology reporting R ectal cancer outcomes are dependent on stage of cancer and appropriate management. The most important management that determines outcome is adequacy of surgical resection. Adjuvant radiation and chemotherapy also have an influence on the outcome. We have previously reported 1996 rectal cancer outcomes in BC. We found that survival and recurrence rates were suboptimal relative to more recent reports from other centres. The British Columbia Cancer Agency (BCCA) provided guidelines for the management of rectal cancer P. Terry Phang, MD, John K. MacFarlane, MD, FRCSC, Robert H. Taylor, MD, FRCSC, Rona E. Cheifetz, MD, FRCSC, Noelle Davis, MD, John H. Hay, MB, Greg McGregor, MD, FRCSC, Caroline Speers, BA, Barry J. Sullivan, MD, FRCSC, Janet Pitts, BA, CHRA(C), and Andrew J. Coldman, PhD