Factors affecting morbidity, mortality and survival in patients undergoing surgery for rectal cancer in a district general hospital.

Introduction: This is a review of elective rectal cancer surgery during 1993-1999 at a single district general hospital to investigate the variables that affected the care of these patients.

Patients And Methods: A retrospective study of patients presenting with rectal adenocarcinoma to a district general hospital where total mesorectal excision was practiced over a 7-year period was performed to identify factors associated with complications, death and disease recurrence.

Results: Sixty-one patients developed a total of 89 complications and 30-day mortality was 8.3%. Overall, 81% of all resections and 86% of potentially curative resections were free of tumour at the circumferential resection margin. A positive circumferential resection margin and 30-day mortality were both associated with increased postoperative blood transfusion volume. Twenty-nine recurrences were detected during the follow-up period (mean, 21.7 months) and circumferential margin involvement by tumour, Dukes' stage, pre-operative functional status (ASA grade) and length of hospital stay correlated with disease-free survival.

Conclusions: Surgical outcomes in lower volume hospitals are comparable with those reported by larger centres.