Influence of hospital- and surgeon-related factors on outcome after treatment of rectal cancer with or without preoperative radiotherapy

BACKGROUND: Preoperative radiotherapy reduces recurrence rates after surgery for rectal cancer but other variables may also affect outcome. The Stockholm Rectal Cancer Study Group has conducted two prospective randomized trials on preoperative radiotherapy in rectal cancer. METHODS: This study analysed postoperative morbidity and mortality, local recurrence rate and death from rectal cancer in 1399 patients, according to different hospital- and surgeon-related factors. RESULTS: Patients operated on by surgeons who were certified specialists for at least 10 years had a lower risk of local recurrence (relative risk 0.8 (95 per cent confidence interval (c.i.) 0.6-1.0)) and death from rectal cancer (relative risk 0.8 (95 per cent c.i. 0.7-0.9)). The risk was also lower for patients operated on in university hospitals (relative risk of local recurrence 0.7 (95 per cent c.i. 0.5-0.9), relative risk of death from rectal cancer 0.8 (95 per cent c.i. 0.7-1.0)) compared with community hospitals, although the results in some community hospitals were similar to those in university hospitals. The proportional reduction of local recurrence rate after preoperative radiotherapy was not significantly different for the studied institutions and surgeons. CONCLUSION: There was a significant surgeon-related variation in patient outcome, which is probably related to the surgical technique. Although improved technique may reduce the local recurrence rate, preoperative radiotherapy is still beneficial concerning local control and survival.