Farella结直肠癌外科进展.pptVIP

EPIDEMIOLOGY Rectal cancer If we consider other surgical options We should take care of: Distal margin Lateral margins Mesorectum General Surgeon vs. Colorectal Surgeon Mortality in patients with co-morbidity of any level of severity General Surg.: 7.3 % Colorectal Surg.: 1.4 % Mortality in severity level 2 and 3 patients General Surg.: 3.8 % - 16.4 Colorectal Surg.: 0.8 % - 5.7% Hospitalization in severity level 2 and 3 patients General Surg.: 16.1 g - 21.2 g Colorectal Surg.: 12.3 g - 17.0 g L Rosen et al Dis Colon Rectum 1996; 39: 129-135 RECTAL CANCER The surgeon as prognostic factor P Hermanek, W Hohenberger, Eur J Surg Oncol 1996; 22:213-215 Analysis of 600 curative rectal resections (GSGCRC). Surgeons enrolling 15 rectal resections in the study expose patients to an increased risk of local recurrence. One or two resections per month are held as a threshold to warrant an optimal local recurrence rate. RECTAL CANCER The surgeon as prognostic factor * * The type of operation and the surgeon as factors affecting oncological outcome in rectal cancer surgery Department of Surgery and Anaesthesia Policlinico S.Orsola-Malpighi University of Bologna ITALY S.FARELLA COLORECTAL CANCER CRC is one of the most important reason of death in Europe and U.S. 300000 new cases and 200000 deaths per year 53.5/100.000 males 37.6/100.000 females In Italy 16.000 new cases in 1970, 37.000 in 1990 e, in 1998, 50.000 in 2000. In England 10.000 nw cases of RC per year with 6.000 deaths In USA, in1995, 39.000 cases of RC with 8.000 deaths Eff. Health Care Ed. it, vol 2 n 5; Sett.ott. 1998 C Cammà et al, JAMA 2000; 284:1008-1015 JM Wheeler et al, Br J Surg 1999; 86:1108-1120 SD Wexner, NA Rotholtz, Dis Colon Rectum 2000; 43:1606-1627 RECTAL CANCER … The technical success of rectal cancer resection is usually measured by permanent stoma rate, incidence of local recurrence and 5-year survival … J.H. Scholefield J. Gastroenterol 2000; 35:126-129 Evolvi