Rural hospitals match city cancer surgery outcomes

The importance of having rural hospitals with the capability to perform colorectal cancer surgery has been reinforced by a new report showing that the short-term and long-term outcomes of this type of surgery performed are comparable to the high standards of metropolitan hospitals.

Compiled from 14 years of results at Mount Gambier Hospital, the study has lead author Associate Professor Matthias Wichmann – from Flinders Rural Health SA and Mount Gambier Hospital – saying it’s an important justification of rural hospitals’ effectiveness and localised support for remote Australian communities.

The incidence of colorectal cancer in Australia is among the highest in the world – and about 29% of Australians live in rural or remote areas, underlining the need for easy access to surgery that can be conveniently accessed by these communities.

Importantly, the findings of the 14-year study – from 2006 to 2020 – support previous reports from briefer time frames that colorectal cancer surgery in rural hospitals is safe and that both short-term and long-term outcomes are good.

“We found that colorectal cancer surgery in a non‐metropolitan surgical centre is safe and associated with low 30‐ and 90‐day mortality rates,” says Associate Professor Wichmann. “Oncological results at 5 and 10 years compare well with the results of other groups.

“It is significant that this surgery can be provided close to the patients’ homes and families in adequately staffed and equipped centres and can match outcomes in capital city hospitals.”

The paper – “Colorectal cancer surgery in rural Australia can match outcomes in metropolitan hospitals: a 14‐year study”, by Matthias Wichmann, Timothy McCullough, Eben Beukes, Thomas Gunning and Guy Maddern – has been published in the Medical Journal of Australia (DOI: 10.5694/mja2.50852).

The report is based on prospectively collected data for 311 patients treated for stages 1 to 3 colorectal cancer by four surgeons in the 110-bed Mount Gambier Hospital, between 1 February 2006 and 31 January 2020. Of these patients, the median age was 71 years (spanning from 63 to 78 years) and 55% were men.

Overall five‐year survival in this study of 79% exceeded the most recent reported value for Australia (2011–2015: 69.9%), and contrasts with a Californian study which found that rural residence was associated with poorer cancer‐specific mortality.

Published data on outcomes beyond 10 years after colorectal cancer surgery are limited, but the overall 10‐year survival rate of 45% stated in the new report is similar to the figures reported by an earlier study in Fremantle (44%).

“Our findings confirm that tumour stage and age at diagnosis are significant predictors of death following curative surgery for colorectal cancer,” says Associate Professor Wichmann.

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College of Medicine and Public Health