Professor Lars Påhlman, a professor and consultant surgeon at the Department of Surgery at University Hospital Uppsala, Sweden, told delegates at ECCO12 - the European Cancer Conference, that five-year survival in patients with a cancer that has always been notoriously hard to treat successfully, had jumped from 50% to 60% in the last 10 years in Sweden
He said that during the 1970s rectal cancer patients fared 5-10% less well than those with colon cancer. Trials using radiotherapy established that the local recurrence rate could be halved from 30% to 15%, but also highlighted the fact that about 50% of patients were being operated upon by surgeons doing less than one rectal cancer operation a year.
He said: "Some centres in Sweden started to concentrate surgery in a few hands and those centres have shown much better results than other centres where there was no concentration. During the late 80s and early 90s, several hospitals were closed due to political reasons. Most of those hospitals were low volume hospitals. Several training courses were established where surgeons were trained in a new technique which gradually, combined with radiotherapy, became a common procedure.
"We started the Swedish rectal cancer registry for quality assurance and control. All rectal cancer patients are registered and now we have five years follow-up indicating that rectal cancer surgery has changed dramatically in Sweden during the last ten years. Rectal cancer patients are now reaching almost 60% five-year survival and have been doing better than colon cancer patients during the last five years.
"Therefore, changes during the last 20 years in Sweden have diminished the local recurrence rate from more than 30% to less than 10%. This reduction is a result of good surgery and selective use of radiotherapy, and has had an enormous impact on cancer survival. To our knowledge, Sweden is the only country where rectal cancer patients are doing better than those with colon cancer.
"A new project in Sweden will be exploring whether this dramatic improvement in survival is due to the fact that previously rectal cancer patients had been treated less well than colon cancer patients and have now reached the same level, or whether there should be a difference between colon and rectal cancer patients and that maybe we should be concentrating on improving the treatment for colon cancer now."
There is no abstract from Professor Lars Påhlman who will be speaking at a special focus session "How to improve cancer care in Europe" on Thursday 25 September at 12.15 hrs CET in Room C1-M5.
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