The Effect of a Multidisciplinary Regional Educational Programme on the Quality of Colon Cancer Resection

Abstract: Mesocolic plane surgery with central vascular ligation produces an oncologically superior specimen following colon cancer resection and appears to be related to optimal outcomes. Aim: We aimed to assess whether a regional educational programme in optimal mesocolic surgery led to an improvement in the quality of specimens. Method: Following an educational programme in the Capital and Zealand areas of Denmark, 686 cases of primary colon cancer resected across six hospitals were assessed by grading the plane of surgery and undertaking tissue morphometry. These were compared to 263 specimens resected prior to the educational programme. Results: Across the region, the mesocolic plane rate improved from 58% to 77% (p<0.001). One hospital had previously implemented optimal surgery as standard prior to the educational programme and continued to produce a high rate of mesocolic plane specimens (68%) with a greater distance between the tumour and the high tie (median for all fresh cases: 113 vs. 82 mm) and lymph node yield (33 vs. 18) compared to the other hospitals. Three of the other hospitals showed a significant improvement in the plane of surgical resection. Conclusion: A multidisciplinary regional educational programme in optimal mesocolic surgery improved the oncological quality of colon cancer specimens as assessed by mesocolic planes, however, there was no significant effect on the amount of tissue resected centrally. Surgeons who attempt central vascular ligation continue to produce more radical specimens suggesting that such educational programmes alone are not sufficient alone to increase the amount of tissue resected around the tumour.