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The Rate of Abdominoperineal Resections for Rectal Cancer in the State of Victoria, Australia: A Population-Based Study

Marwan, K M.R.C.S.1; Staples, M. P. Ph.D.2; Thursfield, V B.Sc., Grad. Dip. (Applied Stats)3; Bell, S. W. F.R.A.C.S.4

doi: 10.1007/DCR.0b013e3181f46485
Original Contribution

PURPOSE: The aim of this study was to document a population-based rate of abdominoperineal resections for adenocarcinoma of the rectum in the state of Victoria, Australia. It also determined whether surgeon caseload or specialist colorectal training affects this rate.

METHODS: All resections for adenocarcinoma of the rectum (International Classification of Diseases for Oncology, 3rd edition C20) that were performed in Victoria in the year 2005 were included. Procedures for rectosigmoid or colon cancer were excluded. The sample was taken from the Victorian Cancer Registry. The rate of abdominoperineal resections was calculated by dividing the total number of abdominoperineal resections by the total number of procedures for rectal cancer. Mixed-effects logistic regression was used to estimate the odds ratio for surgeon caseload and specialist colorectal training.

RESULTS: There were 582 resections available for analysis. Patients were mostly males (66%) and over 60 years of age (67.7%). The overall rate of abdominoperineal resection was 23.4%. The rate of abdominoperineal resections for low rectal cancers was lower (42.8%) among surgeons who had specialist colorectal training compared with those who did not (60.6%) (OR = 2.06; 95% CI, 1.24–3.42).

CONCLUSION: The rate of abdominoperineal resection in Victoria for 2005 was 23.4%. Patients with low rectal cancer operated on by surgeons who had had specialist colorectal training were significantly less likely to undergo an abdominoperineal resection compared with patients undergoing an operation by surgeons who did not have specialist colorectal training.

1Department of Surgery, Monash University, The Alfred Hospital, Prahran, Melbourne, Australia

2Department of Clinical Epidemiology, Monash University, Malvern, Victoria, Australia

3Cancer Epidemiology Centre, Cancer Council Victoria, Carlton South, Victoria, Australia

4Department of Surgery, Monash University, Cabrini Hospital, Malvern, Victoria, Australia

Financial Disclosure: None reported.

Correspondence: Kareem Marwan, M.R.C.S., Monash University, Department of Surgery, The Alfred Hospital, Commercial Rd, Prahran, Melbourne, Australia. E-mail:

© The ASCRS 2010