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

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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.
KCE Reports 81 PROCARE – phase 2 59Table 52. Distal tumour-free margin mentioned in the pathology report,measured with prospective PROCARE data.NPatients with rectal cancer 1071Proportion treated with surgery 1058Proportion treated with sphincter saving surgery or Hartmann’s procedure 815Proportion with pathology data (denominator) 777Proportion with distal tumour-free margin mentioned (numerator) 695 (89%)Number of lymph nodes examinedDEFINITIONNumerator: total number of lymph nodes examined in patients with rectal cancerundergoing radical resection.Denominator: all patients with RC that underwent radical resection.Exclusion:• patients not treated with radical resection• patients treated with local surgeryRESULTSIn the prospective cohort, 1018 patients underwent radical surgery. For 956 patients(94%) the number of lymph nodes examined was available in the database. The meannumber of lymph nodes examined for these patients was 12 (range 0 – 50). In 449patients (47%), the number of lymph nodes examined was 12 or higher. Table 53provides an overview of the number of lymph nodes examined according to theneoadjuvant treatment (n = 584).Figure 14 provides an overview of the per-centre-analysis using the prospectivedatabase (% of patients with at least 12 lymph nodes examined). In three centres allpatients have at least 12 lymph nodes examined, while in four centres the score is 0%.Twenty-seven centres have a score above the weighted (47%; 95%CI 44 – 50%) andunweighted mean (47%; 95%CI 40 – 53%). For the correct interpretation of theseresults, risk-adjustment (neoadjuvant treatment, (y)pN) is necessary.No administrative code exists for the number of lymph nodes examined, which are alsodata that can only be retrieved from the medical file and the anatomopathologicalreport. The QI is therefore not measurable for the administrative cohort.Table 53. Number of lymph nodes examined according to neoadjuvanttreatment, measured with prospective PROCARE data.Type of neoadjuvant treatment N Mean MedianRadiotherapy, 1 – 25 Gy 66 14 12Radiotherapy, 26 – 44 Gy 26 9 10Radiotherapy, 45 Gy or more 415 10 9Radiotherapy, dose unknown 76 13 13No neoadjuvant radiotherapy 1 5 5
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35. Etude relative aux coûts poten
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