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Colorectal Cancer: Audit and Health Economy in Colorectal Cancer Surgery in a Defined Swedish Population
Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
2005 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Colorectal cancer is one of the most common malignancies in Sweden, with more than 5000 new cases annually. Median age at time of diagnosis is approximately 75 years. Owing to the ageing population, the incidence of colorectal cancer is increasing. The improvement in surgical technique and the introduction of adjuvant radio- and chemotherapy increased the 5-year survival rate from approximately 30-40% in the early 1960s to almost 60% in the late 1990s. The cost of public health care has risen considerably, and case-costing systems are increasingly demanded. Linked to clinical guidelines and quality registers, such control systems form a proper basis for quality assurance projects and improvement. The aim of this thesis is to describe the efficiency and cost effectiveness of colorectal cancer treatment in a defined Swedish population. Emergency surgery for colon cancer, constituting 25% of the cases, increased both mortality and cost. Among emergency cases there was not only an increase in postoperative mortality but also a stage specific decrease in long-term survival rate. Correct staging is decisive for further treatment of patients after colon cancer surgery and influences long-term survival. The number of lymph nodes examined varied between different pathology departments and could be used as a quality measurement. The proportion of tumour stage III increased the more nodes examined. A prognostic estimation of stage III cases that is less sensitive to the number of nodes examined is proposed. A case-control study aimed at identifying risk factors for anastomotic leakage after rectal cancer surgery confirmed previously known risk factors but failed to identify further steps during the perioperative course that were amenable to improvement. This research has confirmed that population-based quality and case-costing registers, linked to clinical guidelines, constitute a proper source for projects of quality improvement and decisions about distribution of resources in health care.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis , 2005. , s. 50
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 82
Nyckelord [en]
Surgery, colorectal cancer, colon cancer, rectal cancer, epidemiology, quality assurance, quality control, health economy, survival, hospital category, emergency surgery, lymph nodes, tumour staging, anastomotic leakage, case-control study, surgical complications
Nyckelord [sv]
Kirurgi
Nationell ämneskategori
Kirurgi
Identifikatorer
URN: urn:nbn:se:uu:diva-6056ISBN: 91-554-6388-6 (tryckt)OAI: oai:DiVA.org:uu-6056DiVA, id: diva2:167250
Disputation
2005-11-25, Auditorium Minor, Museum Gustavianum, Akademigatan 3, 753 10 Uppsala, 09:15
Opponent
Handledare
Tillgänglig från: 2005-11-04 Skapad: 2005-11-04Bibliografiskt granskad
Delarbeten
1. Elective surgery for colorectal cancer in a defined Swedish population
Öppna denna publikation i ny flik eller fönster >>Elective surgery for colorectal cancer in a defined Swedish population
Visa övriga...
2004 Ingår i: European Journal of Surgical Oncology, Vol. 30, nr 1, s. 26-33Artikel i tidskrift (Refereegranskat) Published
Identifikatorer
urn:nbn:se:uu:diva-93693 (URN)
Tillgänglig från: 2005-11-04 Skapad: 2005-11-04Bibliografiskt granskad
2. Emergency surgery for colon cancer in a defined population
Öppna denna publikation i ny flik eller fönster >>Emergency surgery for colon cancer in a defined population
Visa övriga...
2005 Ingår i: British Journal of Surgery, Vol. 92, nr 1, s. 94-100Artikel i tidskrift (Refereegranskat) Published
Identifikatorer
urn:nbn:se:uu:diva-93694 (URN)
Tillgänglig från: 2005-11-04 Skapad: 2005-11-04Bibliografiskt granskad
3. Cancer staging and survival in colon cancer is dependent on the quality of the pathologists' specimen examination
Öppna denna publikation i ny flik eller fönster >>Cancer staging and survival in colon cancer is dependent on the quality of the pathologists' specimen examination
2005 Ingår i: European Journal of Cancer, Vol. 41, nr 14, s. 2071-2078Artikel i tidskrift (Refereegranskat) Published
Identifikatorer
urn:nbn:se:uu:diva-93695 (URN)
Tillgänglig från: 2005-11-04 Skapad: 2005-11-04Bibliografiskt granskad
4. Risk factors for anastomotic leakage after rectal cancer surgery, a case-control study
Öppna denna publikation i ny flik eller fönster >>Risk factors for anastomotic leakage after rectal cancer surgery, a case-control study
Manuskript (Övrigt vetenskapligt)
Identifikatorer
urn:nbn:se:uu:diva-93696 (URN)
Tillgänglig från: 2005-11-04 Skapad: 2005-11-04 Senast uppdaterad: 2010-01-13Bibliografiskt granskad

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