Accreditation for colorectal cancer surgery in Italy. Preliminary results of a new program in a district hospital.

Abstract

Accreditation for colorectal (CR) cancer surgery has become a major issue in Italy. This study aimed to analyze the early results of a newly structured program for the treatment of CR cancer in a rural district hospital. Between 2017 and 2018, a total of 214 consecutive patients underwent a CR procedure for malignancy. There were 113 men and 101 women of a mean age of 74 years. Primary CR adenocarcinoma was diagnosed in 210 patients (98%). The incidence of stage I, II, III, and IV disease was 26%, 31%, 24%, and 19% respectively. Hospital volume increased tenfold compared to previous years. Anatomical resection was performed in 204 patients. Right-sided resection and resection of the transverse colon or left angle were performed in 76 (37%) and 14 (7%) patients, respectively. A restorative left sided CR resection was performed in 80 patients (39%), whereas Hartmann procedure and Miles abdominal-perineal resection were performed in 27 (13%) and 6 (3%) patients, respectively. Total colectomy with ileorectal anastomosis was performed in one patient, and two more patients underwent atypical resection. Emergency cecostomy was performed in 15 patients and a colic endoprosthesis was implanted in one patient for obstruction and seven underwent resection afterwards. Laparoscopic resection was performed in 118 patients (57.8%), and the conversion rate was 2%. Overall morbidity, reintervention, and mortality rates were 24.6%, 3,7%, and 3.2%, respectively. The incidence of AL was 4.6%, and two patients died of the consequences of it after right hemicolectomy. Five more elderly patients died for non-surgical related medical complications. The median hospital stay was ten days, and early unplanned readmission rate was 2%. Hospital and surgeon requirements, in terms of minimum volume, organization, and surgical outcome were fulfilled. A rural district hospital can become a tertiary referral center for the surrounding districts without imposing unreasonable travel burdens for patients. CR surgery represents a capital investment for the hospital administration since it shows the effectiveness and quality of care.