Specialist-Delivered Colonic Cancer Surgery in the Irish Model 3 Hospital: A Single-Centre Experience.

Introduction: The proposed centralisation of colonic cancer surgery (CCS) to dedicated cancer centres may overburden such units while removing the opportunity for patients to receive treatment locally. This study presents outcomes of patients undergoing CCS in a regional hospital by a fellowship-trained colorectal surgeon.

Methods: Demographic, perioperative, postoperative, and oncological outcomes for 50 successive patients who underwent CCS in a regional hospital were collected. Outcomes were compared to colorectal cancer key performance indicators and textbook outcomes.

Results: Fifty patients (56% male) were identified, of whom 41 (82%) underwent elective surgery. The median follow-up was 49 months. Operations performed included 31 (62%) right hemicolectomies, 18 (36%) high anterior resections, 1 (2%) subtotal colectomy, and 1 (2%) low anterior resection. The majority (64%, n = 32) were completed laparoscopically. Anastomotic leak rate was 4.3% (n = 2). The major morbidity rate (Clavien-Dindo ≥III) was 14% (n = 7). Readmission, reoperation, and mortality at 30 days were 0%, 8%, and 0%, respectively. The R0 resection rate was 98% with a median lymph node yield of 20. Textbook outcome was achieved in 27 patients (54%). Overall survival at 1, 3, and 5 years was 96%, 77%, and 77%, respectively. Disease-free survival at 1, 3, and 5 years was 86%, 77%, and 75%.

Conclusion: CCS can be delivered safely and effectively in regional hospitals under the care of appropriately supported subspecialists. Both patient and healthcare system benefit from the delivery of high-quality oncological surgery locally, reducing the burden on tertiary centres. The projected doubling of colorectal cancer cases by 2040 requires appropriate utilisation of available resources.