Rectal Cancer Surgery in a District Hospital: Our Experience

Introduction Rectal cancer forms a significant proportion of newly diagnosed colorectal cancer. Treatment of rectal cancer is multi-modal, but surgery remains the cornerstone of treatment of rectal cancer and has undergone significant changes in the last three decades. The advent of minimally invasive techniques has revolutionised the landscape of surgery of the rectum. There is now a growing push to centralise rectal cancer surgery to tertiary centres only. We present the results of rectal cancer surgery from our district hospital. Methods This is a single-centre retrospective review of patients undergoing rectal cancer surgery from January 2018 to December 2019 at Northern Lincolnshire and Goole Trust. Results A total of 104 patients were included, with a mean age of 69.13 years (median 70, range 45-98 years). Of the patients, 65 (62.5%) patients were male and 39 (37.5%) patients were female. Neoadjuvant therapy was given to 34% of patients, while 66% of patients underwent surgery first. Anterior resection was performed in 64% of patients, abdomino-perineal resection was performed in 24% of patients, and Hartmann's type operations were performed in 9% of patients. Median length of stay was 9 days (range 2-78 days). Morbidity was 24%, and five patients had anastomotic leaks, of whom three had radiological drain insertion and two required re-operation. Mortality was 2.,8% and re-operations were performed in 2% of patients. Conclusion Rectal cancer surgery can be safely undertaken in district hospitals with adequately trained surgeons using a multi-disciplinary approach.