The Rectal Cancer Project of the Spanish Association of Surgeons

Abstract

The Spanish Rectal Cancer Project was established in 2006, inspired by the Norwegian Rectal Cancer Project. It consisted of an educational project aiming to introduce mesorectal excision surgery to surgeons, pathologists and radiologists to establish a network of the Spanish National Health Service in Spain.

Methods

All hospitals covering a population area of at least 300,000 inhabitants and operating on more than 12 patients per year were invited to participate. The project was carried out similarly to the Norwegian one. Several “hands on” workshops were arranged yearly between 2006 and 2012. A central registry measured the effectiveness of the project with feedback to participating institutions of their own results compared with the national average.

Results

The National Health System consists of 261 hospitals of which 103 were included in the project. Of these 23 were excluded due to non-compliance with data registration. Therefore, the analysis included results from 80 hospitals covering a geographical area with 19,329,992 inhabitants. From 2006 to 2015 a total of 14,815 patients had a curative resection. The postoperative mortality rate was 1.8%; postoperative complications were observed in 39.9% patients; 10% developed anastomotic leakage and 9% required reoperation. The outcomes observed in 3088 cancer patients who have completed a five-year follow-up were: 6.2% local recurrence, metastasis 18.8% and 73.5% overall survival.

Conclusions

This project shows that the results obtained in Scandinavia have been reproduced in a larger population in Spain applying a similar methodology focused on the spread of competence and auditing of results.