Assurance de qualité pour le cancer rectal – phase 2 ...

58 PROCARE – phase 2 KCE reports 81Exclusion:• patients not treated with TMERESULTSIn 30% of the PROCARE patients undergoing TME, the quality of TME was mentioned inthe pathology report (Table 51). For 76 of the 1058 patients that underwent surgery,no information was available on used surgical technique (total missings: 76/1071, 7%).Importantly, registration of the quality of TME only gradually started in November 2006.Therefore, the reported result is probably an underestimation.This QI is measurable for 56 centres using the prospective database. Five centres have ascore of 100%, while 26 centres score 0%. Twenty-four centres have a score above theweighted (30%; 95%CI 27 – 33%) and unweighted mean (29%; 95%CI 19 – 38%). For thecorrect interpretation of these results, risk-adjustment (tumour localisation, stage) isnecessary.No administrative code exists for the result of a TME quality assessment, which in factis information that can only be retrieved from the medical file and theanatomopathological report. The QI is therefore not measurable for the administrativecohort.Table 51. Quality of TME mentioned in the pathology report, measured withprospective PROCARE data.NPatients with rectal cancer 1071Proportion treated with surgery 1058Proportion treated with TME (denominator) 833Porportion with quality of TME mentioned in the pathology report (numerator) 252 (30%)Distal tumour-free margin mentioned in the pathology reportDEFINITIONNumerator: all patients with RC that underwent sphincter saving surgery or Hartmann’sprocedure having their distal tumour-free margin mentioned in the pathology report.Denominator: all patients with RC that underwent sphincter saving surgery orHartmann’s procedure.Exclusion:• patients not treated with sphincter-sparing surgery or Hartmann’sprocedureRESULTSIn 89% of the PROCARE patients undergoing sphincter saving surgery or Hartmann’sprocedure the distal tumour-free margin is mentioned in the pathology report (Table52). For 51 of the 1058 patients undergoing surgery, no information was available onthe type of reconstruction. Above this, for 38 patients undergoing sphincter savingsurgery or Hartmann’s procedure, no pathology data were available (total missings:89/1071, 8%).This QI is measurable for 53 centres using the prospective database. Twenty-threecentres have a score of 100%. Thirty-four centres have a score above the weighted(89%; 95%CI 87 – 92%) and unweighted mean (89%; 95%CI 84 – 94%). For the correctinterpretation of these results, risk-adjustment (tumour localisation) is necessary.No administrative code exists for the distal tumour-free margin, which are also datathat can only be retrieved from the medical file. The QI is therefore not measurable forthe administrative cohort.