Changes in Colorectal Cancer Care in Japan before and after Guideline Publication: A Nationwide Survey about D3 Lymph Node Dissection and Adjuvant Chemotherapy

BACKGROUND: The Japanese Society for Cancer of the Colon and Rectum (JSCCR) published clinical guidelines for the treatment of colorectal cancer (CRC) in 2005. To evaluate the impact of these guidelines on clinical practice nationwide, we examined the change in the proportion of patients receiving the recommended CRC treatments. STUDY DESIGN: We collected treatment information on patients with stage II and stage III CRC who underwent surgery in participating facilities between 2001 and 2010. We focused on the performance of 2 treatments recommended by the JSCCR-guidelines: D3 lymph node dissection and postoperative adjuvant chemotherapy. RESULTS: The data of 46,304 patients treated in 96 institutions were collected. The proportion of patients receiving D3 dissection increased over time from 58.4% in 2001 to 75.0% in 2010. The increase accelerated after the publication of the JSCCR guidelines in 2005 (2.5% from 2001 to 2005 vs 14.1% from 2005 to 2010). Similarly, the percentage of stage III patients receiving adjuvant chemotherapy increased over time from 50.8% in 2001 to 71.0% in 2010, but the increase was smaller after guideline publication (16.3% between 2001 and 2005 vs 3.9% from 2005 to 2010). Although the performance of each of the recommended treatments varied substantially among institutions, the variation decreased over time. CONCLUSIONS: D3 dissection for stage II to III disease and adjuvant chemotherapy for stage III disease have become more prevalent and the variation in performance among institutions has decreased in the last decade. Importantly, publication of the guidelines has accelerated the spread of surgical standards. (C) 2014 by the American College of Surgeons