The National Bowel Cancer Project: Social Deprivation Is an Independent Predictor of Nonrestorative Rectal Cancer Surgery

被引:16
作者
Tilney, Henry [1 ]
Lovegrove, Richard E. [1 ]
Smith, Jason J. [2 ]
Thompson, Michael R. [3 ]
Tekkis, Paris P. [1 ]
机构
[1] Univ London Imperial Coll Sci Technol & Med, St Marys Hosp, Dept Biosurg & Surg Technol, London W2 1NY, England
[2] W Middlesex Hosp, Dept Surg, London, England
[3] Queen Alexandra Hosp, Dept Surg, Portsmouth, Hants, England
关键词
Rectal cancer; Outcomes; Social deprivation; Abdominoperineal resection; RESECTION MARGIN INVOLVEMENT; TOTAL MESORECTAL EXCISION; QUALITY-OF-LIFE; ABDOMINOPERINEAL RESECTION; COLORECTAL-CANCER; ANTERIOR RESECTION; MORTALITY; OUTCOMES; THERAPY; RATES;
D O I
10.1007/DCR.0b013e3181a65f41
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
PURPOSE: This study was designed to assess the impact of social deprivation on rates of abdominoperineal excision of the rectum in the United Kingdom. METHODS: Data were extracted from the Association of Coloproctology of Great Britain and Ireland Colorectal Cancer Database (2000-2005). Social deprivation was assessed by using the Index of Multiple Deprivation (2004) score. Logistic regression was performed to identify independent predictors of nonrestorative surgery. RESULTS: A total of 12,128 patients underwent anterior resection or abdominoperineal excision for Dukes A-C cancer in 101 centers; 2,625 patients (21.6 percent) underwent abdominoperineal excision (median, 20.8 (interquartile range, 16.5-27.9) percent per unit). Abdominoperineal excision rates decreased from 24.3 to 18.2 percent (P < 0.001) and varied between the least and most deprived groups from 18 to 26.4 percent, respectively (P < 0.001). Independent predictors of abdominoperineal excision were: year of surgery (odds ratio = 0.855 per year increase, P < 0.001), female vs. male gender (odds ratio = 0.82, P < 0.001), use of neoadjuvant radiotherapy (odds ratio = 2.4, P < 0.001), and social deprivation (most vs. least deprived: odds ratio = 1.638, P < 0.001). CONCLUSIONS: Abdominoperineal excision rates vary considerably between centers. Gender and deprivation status independently predict formation of a permanent stoma. These results have important implications for intercenter comparisons of surgical quality and may suggest inequalities in health care provision.
引用
收藏
页码:1046 / 1053
页数:8
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