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Surgery has a key role for quality assurance of colorectal cancer screening programs: impact of the third level multidisciplinary team on lymph nodal staging

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

From 2011 to 2013 in the area of the Naples 3 public health district (ASL-NA3), a colorectal cancer screening program (CCSP) was developed. In order to stress the need of quality assurance procedures for surgery and pathology, a third level oncologic pathway was added and set up at a referral colorectal cancer center (RC). Lymph nodal (LN) harvesting, as a process indicator, and nodal positivity were adopted for an interim analysis.

Methods

The program was implemented by a series of audit meetings and a double type of multidisciplinary team (MDT): “horizontal” and “vertical.” Three hundred and forty colorectal cancer (CRC) patients underwent surgery: 119 chose to be operated at the RC (Gr In), 65 were operated at 22 district hospitals (DH) (Gr Out), and 156 symptomatic not screened patients were operated at the RC (Gr Sym).

Results

Statistical analysis revealed differences between Gr In and Gr Out colon groups both for LN harvesting (median of 26 and 11, respectively, P = 0.0001), and for nodal positivity after the first screening round (34.78 and 19.45 %, respectively, P = 0.0169). Results were all the more significant in a subset analysis on early T stage colon subgroups (In vs Out) both for LN harvesting (P < 0.0001) and nodal positivity (P < 0.0001).

Conclusion

xSignificant differences between RC and DHs were found, particularly for early-stage CRC patients. LN harvesting should be considered as a surrogate marker of quality assurance for at least screening hospitals for “minimum best” standard of care. This should lead to set up a third level in any CCSP.

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Acknowledgments

The authors are grateful to Dr. Maurizio D’Amora, Dr. Raffaele Palombino, and Mrs. Mariacristina Romano.

Financial support

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Authors and Affiliations

  1. Department of Surgical Oncology, Istituto Nazionale per lo studio e la cura dei tumori “Fondazione Giovanni Pascale” - IRCCS, Via M. Semmola, 80131, Naples, Italy

    Francesco Bianco, Silvia De Franciscis, Andrea Belli, Maria Di Lena & Giovanni Maria Romano

  2. Department of Medical Oncology, Istituto Nazionale per lo studio e la cura dei tumori “Fondazione Giovanni Pascale” - IRCCS, Naples, Italy

    Antonio Avallone

  3. Gastroenterology and Digestive Endoscopy, Maresca Hospital, Torre Del Greco, Italy

    Maria Antonia Bianco & Gianluca Rotondano

  4. Gastroenterology and Digestive Endoscopy, Apicella Hospital, Pollena Trocchia, Italy

    Sabato Di Marzo

  5. Epidemiology and Prevention Unit, ASL NA3sud, Naples, Italy

    Letizia Gigli & Silvana Russo Spena

  6. Department of Pathology, Istituto Nazionale per lo studio e la cura dei tumori “Fondazione Giovanni Pascale” - IRCCS, Naples, Italy

    Fabiana Tatangelo

  7. Department of Endoscopy, Istituto Nazionale per lo studio e la cura dei tumori “Fondazione Giovanni Pascale” - IRCCS, Naples, Italy

    Alfonso Tempesta

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  1. Francesco Bianco
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  2. Silvia De Franciscis
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  3. Andrea Belli
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  13. Giovanni Maria Romano
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Correspondence to Francesco Bianco.

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Bianco, F., De Franciscis, S., Belli, A. et al. Surgery has a key role for quality assurance of colorectal cancer screening programs: impact of the third level multidisciplinary team on lymph nodal staging. Int J Colorectal Dis 31, 587–592 (2016). https://doi.org/10.1007/s00384-015-2472-7

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  • DOI: https://doi.org/10.1007/s00384-015-2472-7

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