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Postoperative deaths from bowel cancer fall for fourth year in row, audit shows

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8518 (Published 17 December 2012) Cite this as: BMJ 2012;345:e8518
  1. Gareth Iacobucci
  1. 1BMJ

The proportion of postoperative deaths from bowel cancer has fallen for the fourth year in succession, show the latest findings from the National Bowel Cancer Audit, although the high number of emergency admissions of people with the condition remains a “major concern.”

The audit, which examined data from more than 29 000 patients whose bowel cancer was diagnosed in 2010-11, found that 5.1% of these patients had died 90 days after their operation, down from 6.4% of those whose disease was diagnosed in 2007-8.

The report, produced by the NHS Health and Social Care Information Centre, the Association of Coloproctology of Great Britain and Ireland, and the Royal College of Surgeons of England, said that the trend coincided with an increase over the same period in the proportion of laparoscopic operations, which rose from 25% of patients who underwent surgery to 40%.1

It found that laparoscopic surgery was associated with shorter hospital stays (six days, rather than the nine days among patients who underwent open surgery) and a reduced risk of postoperative death (2.6% for laparoscopic surgery against 6.7% for open surgery).

But it warned that 21.1% of patients with bowel cancer were admitted as emergency cases with severe and potentially life threatening symptoms and that almost a third of these patients (30%) were unsuitable for surgical intervention. Some 12% of patients who underwent emergency surgery died within 90 days of the operation.

The audit also raised concerns that 38% of patients still had a “temporary” stoma 12 months after undergoing operations to remove rectal cancer. It said that further investigation was needed to determine whether these delays were caused by further treatments, such as postoperative chemotherapy, or by a lack of operating time.

Nigel Scott, audit clinical lead and consultant colorectal surgeon at the Royal Preston Hospital, said that the audit was an important tool for helping to tackle a “very significant health problem.”

He said, “Symptom awareness campaigns are useful to break down the taboos of bottoms and bowels that lock these symptoms behind the bathroom door. But emergency surgery continues to be the Cinderella of surgical practice in the UK.

“A recent survey of surgeons highlighted that the NHS pressures currently work against emergency cases, with 55% of surgeons describing inadequate emergency theatre access. Only 15% of emergency surgeons have a comprehensive interventional radiology service out of hours, and this deficiency has a major detrimental effect on the use of colonic stenting for the emergency colorectal cancer admission. These findings are also mirrored in a recently published report by the Department of Health and the Royal College of Surgeons.”

The report was commissioned by the Healthcare Quality Improvement Partnership, led by the Academy of Medical Royal Colleges, the Royal College of Nursing, and National Voices.

Notes

Cite this as: BMJ 2012;345:e8518

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