Predictors of Multivisceral Resection in Patients with Locally Advanced Colorectal Cancer
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Practice guidelines recommend en bloc multivisceral resection (MVR) for all involved organs in patients with locally advanced adherent colorectal cancer (LAACRC) to reduce local recurrence and improve survival. We found that MVR was performed in one-third of eligible American patients in the Surveillance, Epidemiology and End Results cancer registry but that study could not identify factors amenable to quality improvement. This study was conducted to examine rates, and predictors of MVR among Canadian patients with LAACRC.
Rates of MVR were examined by observational study. Eligible patients were aged 20–74 years who had surgery for nonmetastatic LAACRC from July 1997 to December 2000. Patient, tumor, surgeon, and hospital characteristics were extracted from medical records. Summary statistics were compared by type of surgery (MVR, partial MVR, standard resection). To identify factors associated with MVR we analyzed operative notes and transcripts from interviews with general surgeons using standard qualitative methods.
Factors associated with MVR included fewer years in practice, preoperative treatment planning, involvement of surgical consultants, and access to diagnostic imaging and systems to enable preoperative multidisciplinary planning. Judgments regarding the nature of peritumoral adhesions, resectability, and personal technical skill may mediate decision-making. Many surgeons would prefer to refer patients than undertake complicated, lengthy cases.
Further research is required to validate these findings in larger studies and among patients undergoing surgery for conditions other than LAACRC, and evaluate strategies to improve rates of MVR through enhanced individual awareness and system capacity.
Key WordsColorectal neoplasms Multivisceral resection Decision-making Practice guideline adherence Continuing education Quality improvement
This work was supported by a research grant from the National Colorectal Cancer Campaign (now Colon Cancer Canada). This work was made possible through collaboration and cooperative agreements with the Colon Cancer Family Registry and P.I.s. The content of this manuscript does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating institutions or investigators in the Colon CFR, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government or the Colon CFR. RFA #CA-95-011, ID # C-EX-0506-03.
- 2.Canadian Cancer Society/National Cancer Institute of Canada (2006) Canadian Cancer Statistics. Available: http://www.cancer.ca [accessed June 8, 2007]
- 15.Davis DA, Taylor-Vaisey A. Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. Can Med Assoc J 1997; 157:408–16.Google Scholar
- 16.Oxman AD, Thomson MA, Davis DA, et al. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. Can Med Assoc J 1995; 153:1423–31.Google Scholar
- 23.Greene FL. Dictation of the operative note – a forgotten art form. Gen Surg News 2004; 31:1–6.Google Scholar
- 24.Strauss A, Corbin J. Basics of qualitative research: grounded theory procedures, techniques. Newbury Park, CA: Sage, 1990.Google Scholar
- 27.Auerbach CF, Silverstein LB. Qualitative data: an introduction to coding and analysis. New York: New York University Press, 2003.Google Scholar
- 41.Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ Theory Pract 2007; Nov 27 (epub)Google Scholar