Audit of Surgery for Colorectal Cancer

Study Overview
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Brief Summary
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The aim of this project is to audit the surgical care in patients treated for colorectal adenocarcinoma. This study focused on collecting data from all consecutive cases of colon and rectal adenocarcinoma operated at the National Institute of Oncology in Rabat during a two-years period. Using standardized forms, the investigators collected data relating to each stage of treatment: pre-therapeutic, surgical and post-operative in order to measure the quality of the surgical care delivered. These results were compared to established benchmarks and to similar audit studies carried out in other countries around the world.

Detailed Description
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Quality improvement initiatives and in particular the accreditation procedure raises the inevitable question of measuring quality in health. Several surgical audits have been carried out internationally, showing the importance of collecting reliable and valid information on the quality of care. This approach allows an evaluation and improvement of the quality of care provided, significantly correlated to a direct impact on morbidity and mortality. In addition, it provides valuable information for evidence-based medicine research as it provides data on patients often excluded from therapeutic trials. Colorectal cancer is the first digestive cancer and the third cancer worldwide. Surgical resection is the main curative treatment. Surgical quality is associated with better short and long term results. Quality improvement measures, with the goal to improve surgical care of colorectal cancer, are becoming a standard worldwide. The aim of this project is to audit the surgical care in patients treated for colorectal adenocarcinoma. This study focused on collecting data from all consecutive cases of colon and rectal adenocarcinoma operated at the National Institute of Oncology in Rabat. Using standardized forms, the investigators collected data relating to each stage of treatment: pre-therapeutic, surgical and post-operative in order to measure the quality of the surgical care delivered. These results were compared to established benchmarks and to similar audit studies carried out in other countries around the world.

Official Title
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Audit of the Quality of Surgical Treatment of Colorectal Cancer

Conditions
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Rectal Adenocarcinoma, Colon Adenocarcinoma

Intervention / Treatment
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* Procedure: Colorectal resection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with histologically proven colorectal adenocarcinoma who underwent surgical resection with curative intent between 1 January 2018 and 31 December 2019. Exclusion Criteria: Colon or rectal resections for other histologic types than adenocarcinoma. Palliative intent surgery.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Colon adenocarcinoma<br>Patient who underwent surgical resection for colon adenocarcinoma | Procedure: Colorectal resection<br>* Colon or rectal resection for colorectal adenocarcinoma<br>|
| Rectal adenocarcinoma<br>Patient who underwent surgical resection for rectal adenocarcinoma | Procedure: Colorectal resection<br>* Colon or rectal resection for colorectal adenocarcinoma<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Retrieved lymph nodes | Number patients with retrieved lymph nodes after colon resection above 12 | 1 month after surgery | 
| Positive circumferential margin | The rate of patients with circumferential margin < 1 mm on surgical specimen of rectal resection for rectal adenocarcinoma. | 1 month after surgery | 
| Morbidity | Morbidity assessed using using the Clavien-Dindo grading system at discharge and at 90 days after surgical resection for colorectal adenocarcinoma | 90 days after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pre-operative CT-scan | Rate of patients who had computed tomography before surgery | 7 days after surgery | 
| Multidisciplinary team meeting | Rate of cases who were discussed during a multidisciplinary team meeting before surgery for patients who had surgical resection for colorectal adenocarcinoma | 7 days after surgery | 
| MRI for rectal adenocarcinoma | Rate pf patients who had a pelvic Magnetic resonance imaging or rectal ultra-sonography in the pre-operative work-up of rectal adenocarcinoma | 7 days after surgery | 
| Anastomotic leakage | Rate of anastomotic leakage after resection of colorectal cancer with the creation of anastomosis | 90 days after surgery | 
| Readmission | Rate of hospital readmissions leakage after resection of colorectal cancer | 90 days after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rectal neoplasms, Colon neoplasms