S. L. Due MBChB, BSc (Med); D. A. Wattchow PhD, FRACS, MBBS; J. L. Sweeney FRACS, MBBS;. L. Milliken; C. G. Luke MD, MBBS.
Colorectal cancer surgery 2000–2008: evaluation of a prospective database
Article first published online: 26 APR 2012
© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons
ANZ Journal of Surgery
Volume 82, Issue 6, pages 412–419, June 2012
How to Cite
Due, S. L., Wattchow, D. A., Sweeney, J. L., Milliken, L. and Luke, C. G. (2012), Colorectal cancer surgery 2000–2008: evaluation of a prospective database. ANZ Journal of Surgery, 82: 412–419. doi: 10.1111/j.1445-2197.2012.06078.x
- Issue published online: 3 JUN 2012
- Article first published online: 26 APR 2012
- Accepted for publication 30 October 2011.
- clinical audit;
- colorectal neoplasms;
- colorectal surgery;
Background: Colorectal cancer is a common cause of cancer death in Australia and is primarily managed operatively. Surgical databases are valuable in monitoring performance in cancer treatment and detecting problems and trends.
Methods: Diagnostic and treatment variables and short-term outcomes were gathered prospectively for patients undergoing resection for colorectal cancer over a 9-year period. Survival data were obtained by linkage to state and interstate death indices.
Results: Eight hundred and five patients underwent resection for colorectal cancer during the study period. Overall 5-year survival was 61%. Five-year cancer-specific survival was 73%. Five-year cancer-specific survival for Australian Clinico-Pathological Staging (ACPS) stages A, B, C and D was 96, 80, 61 and 19%, respectively (P < 0.0001). Emergency presentations showed diminished survival (59% versus 75%, P < 0.0001) after controlling for age and stage (hazard ratio (HR) 1.78, P= 0.005), as did transfusion recipients (63% versus 74%, P= 0.0014; HR 1.78, P= 0.004). Anastomotic leak did not affect survival in multivariable analysis. Non-cancer causes accounted for 26% deaths, primarily comprising cardiovascular deaths in the elderly.
Discussion: High case ascertainment, data completeness and accuracy can be obtained with prospective, independently gathered data linked electronically to national death records. Survival for colorectal cancer in South Australia continues to improve. Close follow-up for disease recurrence is warranted for transfusion recipients, emergencies and advanced disease. Locally managed databases with linkage to state registries and other institutions are powerful methods to improve data quality and surgical care at a national level.