Surgical rates for rectal cancer at NNUH revealed

Surgeons have revealed that cancer patients treated at the Norfolk and Norwich University Hospital are a lot less likely to have an operation that can leave them with a permanent colostomy than the national average.

Guidance from the Department of Health and the National Institute for Clinical Excellence (NICE) suggests that no more than 30 per cent of rectal cancer operations should involve a procedure called abdominoperineal excision (APE). The Norfolk and Norwich University Hospital (NNUH) APE rate was 12.5 per cent for 2006/07 and 18 per cent for 2005/06.

Every year in the UK, approximately 13,000 people are diagnosed with rectal cancer, and 5,000 die from the disease. NNUH treats approximately 100 rectal patients a year. Although radiotherapy and chemotherapy can be used to tackle rectal cancer, it is often necessary to try and surgically remove the tumour and then rejoin, as far as possible, the tissues of the rectum and anus.

The surgical treatment plan depends on the size of the cancer and its position, and the lower the tumour extends, the more likely it is that APE will be the only option for some patients. Fitness and lifestyles issues also have to be taken into account.

Recently published research by Leeds University reports that the APE operation, which leaves patients with a permanent colostomy, may have been used too often in some hospitals. Their research compared the rates of two types of operation used in rectal cancer, the abdominoperineal excision (APE), and anterior resection (AR).

The research looked at records of operations carried out in England between 1998 and 2004, and found that APE had declined from just over 30 per cent of all operations to 23 per cent over that period but that the rate exceeded 40 per cent in some areas.

NNUH consultant colorectal surgeon Mr Richard Wharton said: “Our rates for APE last year were 12.5 per cent which achieves the target figure of the rate being below 30 per cent, as suggested by the NICE guidelines. The data quoted in the published research from Leeds University is as much as 10 years old and relying on historical data that old may not be helpful.”