Risk adjusted benchmarking of abdominoperineal excision for rectal adenocarcinoma in the context of the Belgian PROCARE improvement project
Gut, 05/25/2012

Penninckx F et al. – Significant variation of the APE rate was observed. Adjustment for confounding factors as well as merging Hartmann resections (HR) with abdominoperineal excision (APE) rates were found to be important for the assessment of performances.

• Data of 3197 patients who underwent elective radical resection for invasive rectal adenocarcinoma up to 15 cm were registered between January 2006 and March 2011 by 59 centres, each with at least 10 patients in the registry.
• Variability of APE or merged APE/HR rates between centres was analysed before and after adjustment for gender, age, ASA score (3 or more), tumour level (rectal third), depth of tumour invasion (cT4) and preoperative incontinence.

• The overall APE rate was 21.1% (95% CI 19.7 to 22.5%).
• Significant variation of the APE rate was observed before and after risk adjustment (p<0.0001).
• For cancers in the lower rectal third, the overall APE rate increased to 45.8% (95% CI 43.1 to 48.5%).
• Also, variation between centres increased. Risk adjustment influenced the identification of outliers.
• HR was performed in only 2.6% of patients.
• However, merging of risk adjusted APE and HR rates identified other centres with outlying definitive colostomy rates than APE rate alone.