Bowel cancer surgery survival rates “worrying” experts

By Dr. Ananya Mandal, MDApr 11 2011

In a new study that looked into post-operative death rates for one of the most common cancers, trends look worrying. On average 6.7% of patients died within a month of undergoing surgery for bowel cancer in England between 1998 and 2006. Patients face a seven-fold higher risk of dying after surgery in some NHS trusts than others, the study shows.

But a closer look at the period between 2003 and 2006 revealed wide variation between the worst and best performing centers. The proportion of patients dying soon after surgery ranged from around 2% for Central Manchester University Hospitals NHS Foundation Trust, to more than 15% for Burton Hospitals NHS Foundation Trust. Other centers also showed wide variations;

• Whittington Hospital NHS Trust, Rotherham NHS Foundation Trust, Northampton General Hospital NHS Trust and Colchester Hospital University NHS Foundation Trust - had death rates above 10%.
• Countess of Chester Hospital NHS Foundation Trust and Shrewsbury and Telford Hospital NHS Trust, had rates below 5% and much better than the national average

The variations remained after adjustments to take account of patient populations, underlying health problems, and case loads. Hospitals in England had a consistently worse record than those in some other countries, the study found. In Scandinavia, Canada and the United States, bowel cancer 30-day post-operative death rates ranged between 2.7% and 5.7%.

Authors from the University of Leeds and the London School of Hygiene and Tropical Medicine write, “This [difference] suggests that either the NHS may have fundamentally worse post-operative outcomes than some other comparable health services, or the operative risk of patients differs between countries. Understanding and minimizing these differences could significantly reduce the number of premature deaths caused by this disease across the country.” The findings, published in the journal Gut, were described as “worrying” by leading charity Cancer Research UK, which funded the study.

But the Government's “cancer tsar” Professor Mike Richards, who oversees cancer strategy at the Department of Health, insisted there were reasons to be optimistic about the long-term trend. He pointed to new figures, not reported in the study, showing marked improvements among the poorest performing hospitals between 2007 and 2008 that had narrowed the postcode gap.

Professor Paul Finan, one of the researchers, who works for Leeds General Infirmary and the NCIN, said, “It's very encouraging to see that overall the 30-day post-operative mortality rate is decreasing across the country. But, having adjusted for those factors that can affect post-operative mortality, it is a concern that there is significant variation between hospitals. Understanding why this has occurred is a complex matter and is now a priority for the NCIN and the wider cancer community. It's vital to learn from the trusts with very low post-operative mortality so that we can identify and spread best practice across the NHS and so help to reduce post-operative mortality further.”

Dr Lesley Walker, Cancer Research UK's director of cancer information, said, “Thirty-day mortality data following bowel cancer surgery is one of the key measures used by surgeons and the cancer care teams to monitor their progress. The evidence provided here asks a number of important questions which we now need to answer. Getting the best UK cancer data that we can is crucial to any meaningful analysis of our record on cancer and must be a priority for the NHS.”

Bowel cancer is the third most common cancer (after lung and breast) with 35,000 cases and 16,000 deaths a year. The new study looked at data from more than 160,000 patients who had surgery for bowel cancer, carried out by 150 hospital teams.