Major surgical resections
England, 2004-2006
national cancer
intelligence network
Major surgical resections
England, 2004-2006
www.ncin.org.uk
Contents
Introduction
Page 3
Page 4
Page 6
Page 7
Page 8
Background
Methods
Summary of results
Limitations
Next steps
NHS treated patients with a record of a major resection, by site
Page 10
Page 12
Page 14
Page 16
C15: Oesophagus
C16: Stomach
C22: Liver
C25: Pancreas
Page 18
C18-C20: Colorectal
Page 20
C33-C34: Trachea, bronchus and lung
Page 22
C50: Breast
Page 24
Page 26
Page 28
C53: Cervix
C54-C55 : Uterus
C56: Ovary
Page 30
Page 32
Page 34
C61 : Prostate
C64-66 & C68 : Kidney
C67: Bladder
Glossary
Page 36
Page 38
Page 39
Glossary
Appendix 1: Patients linked to HES
Appendix 2: OPCS-4 codes assigned to each site
1
2
Introduction
Background
Surgery is the treatment that has the greatest impact on long term survival in most types of cancer. It
can also serve the purpose of significantly improving symptoms, even in situations where long term
survival is unrealistic. A more detailed understanding of the patterns of surgical treatments in cancer is
therefore vital to efforts to improve outcomes for cancer patients. The need to develop better
knowledge and understanding of treatment was a central aim of the Cancer Reform Strategy. This
project is the first attempt to look in more detail at surgical treatment for patients across a wide variety
of cancer types in England. This report is best seen as the beginning of a process in which we aim,
over time, to relate treatment rates to survival and other outcomes, to establish ‘benchmarks’ for good
practice and to provide data both to health care providers and commissioners that we hope will help
drive up standards of care.
The main source of routine data collection of surgical procedures within the NHS is the Hospital
Episode Statistics (HES) dataset, collected though trusts submitting relevant data for their patients.
These data are used for the reimbursement of trusts for their surgical activity. Recently, the National
Cancer Intelligence Network (NCIN) facilitated the linkage between the national cancer registry data
held by the English cancer registries, and an extract of all HES records relating to cancer patients. This
has resulted in the National Cancer Data Repository (NCDR), enabling the analyses presented in this
report.
The National Cancer Data Repository holds cancer registration data for the whole of England combined
with over 10 million individual entries of hospital episodes. This provides an unparalleled resource for
exploring hypotheses and evaluating quality of care. Further information about the National Cancer
Data Repository is available from the NCIN website www.ncin.org.uk.
The proportion of patients who undergo surgical operations as part of their treatment is available
nationally for bowel, head and neck, lung, oesophago-gastric cancers and mastectomy and breast
reconstruction through national cancer audits. See http://www.ic.nhs.uk for more details. Analyses by
cancer networks in these audit reports are either the network where the patient is first seen in
secondary care (usually the Multi-Disciplinary Team) or in which patients receive their treatment. In the
work presented here, we have used the area of residence of patients in the analyses, which will result
in some apparent discrepancies at a local level if the results are compared directly with audit data.
Their reports may also cover different time periods. In addition, the results presented in this report
may differ because of the use of different surgical procedure codes from those used in the national
audits. This is because, for the present analysis, we have chosen to focus on what the clinical experts
in their respective fields have identified as the relevant ‘Major Surgical Procedures’, some of which
may well be carried out with ‘palliative’ rather than ‘curative’ intent.
This report represents a significant step forward in providing national level analyses for the surgical
treatment of a wide range of common cancer sites using routine information on surgical procedures
derived from HES. This is the first report that brings together information of this nature using a
common methodology and produces a common set of outputs specifically for major resections across
such a wide range of cancer types.
By bringing together cancer registrations with information regarding operations and procedures
undertaken within the NHS, we can present analyses of the data that is available and start to ask
questions as to why any apparent differences are seen.
3
This is the first step in understanding variations in surgical treatment which we hope will provide the
intelligence to raise standards of care and help improve outcomes for cancer patients.
In undertaking this analysis, we attempted to answer the following questions:
•
Is it possible to use routine HES data to ascertain the proportion of patients who received a
major resection as part of their treatment?
•
Are there differences in surgical rates between the sexes, age groups and those in different
deprivation quintiles?
•
What is the variation across the country based on the cancer network to which patients are
assigned using their postcode of residence?
Methods
The primary aim of this report was to produce a first exploratory analysis using routine data from
hospitals to determine the percentage of patients who have a record of a major resection in England
and whether any variation between inequality groups exist. Major resections were classified as nondiagnostic surgical operations which would be carried out with intent to remove the tumour.
The HES database contains records for every in-patient and/or day case stay for each patient attending
an NHS hospital in England and includes information regarding the procedures, operations and
corresponding dates performed during each episode. Each episode can contain up to 12 different
codes describing the procedure or operation that a patient underwent. Operations and procedures are
recorded using a classification system called OPCS. All OPCS codes and their descriptions used for
each site are included in the appendix of this report.
Clinicians from the NCIN’s Site Specific Clinical Reference Groups (SSCRGs) and staff from cancer
registries in England were involved in this work and helped to determine which relevant OPCS codes
should be included as a major resection for each cancer site, given that a patient had a diagnosis of
cancer.
For certain sites there are diagnostic procedures which may also remove the tumour, for example loop
and cone biopsies for cervical cancer. However, without data such as stage of disease at diagnosis, it is
not possible to say retrospectively whether the tumour would have been removed and therefore these
operations were not included as “major resections”. Patients with certain tumours may also undergo
surgery that won’t remove the tumour but will instead aim to debulk the tumour before radiotherapy or
chemotherapy. Therefore, the percentage of patients who have received surgery as part of their care
may well be higher for some sites than the percentage of patients who receive a major resection as
presented in this initial report.
All patients diagnosed with a malignant neoplasm from 2004 to 2006 (inclusive) were extracted from
the NCDR in January 2010 for cancer of the oesophagus (C15), stomach (C16), liver (C22), pancreas
(C25), colorectal (C18-C20), lung (C33-C34), breast (C50), cervix (C53), uterus (C54-C55), ovary
(C56), prostate (C61), kidney (C64-C66 & C68) and bladder (C67). All codes in brackets relate to the
ICD-10 codes included for each site.
4
The National Cancer Data repository also holds data obtained from linking patients with the Hospital
Episode Statistics Database (HES). All linked HES records from 2003 to 2007 were extracted for
cancer patients from the national cancer data repository in October 2010.
All OPCS procedures from HES for a given patient were included in the analysis. A patient was either
classified as having a record of a major resection or not. It is possible that patients had a record of
more than one OPCS code that was assigned as a major resection for their treatment. These patients
have been included once in the analyses as having received a major resection.
A timeframe of 30 days before diagnosis date and up to six months post diagnosis was used to restrict
the surgery to the relevant cancer diagnosis and not a recurrence. For cancers of the breast, uterus,
ovary and cervix, a period of up to one year post diagnosis was used. This is because, for these
cancers, patients may undergo a course of chemotherapy, radiotherapy or both, before a major
resection is performed. Any procedure outside the allocated timeframe was not attributed to that
diagnosis and therefore excluded from these analyses.
Exclusions were also made where a patient was diagnosed as a result of being registered solely on the
basis of a death certificate (Death Certificate Only registration – DCO). As DCO registrations are
unlikely to have known about their tumour before their death, it would not be appropriate to include
them within these analyses. The proportion of patients classified as a DCO varies with site. In addition,
any records with missing information regarding date of diagnosis, place of residence at diagnosis or
age of patient were also excluded from the analysis. The quality of our data has not made it possible for
us to attempt to correct the findings for the stage of disease or for co-morbidity, although we have
examined the effects of age and socio-economic deprivation
As data is only available for patients treated in NHS hospitals, any patients who could not be matched
to at least one hospital episode were also excluded from the analysis as we did not know whether they
may have received a major resection outside of the NHS. Data for patients who are treated privately
are not currently available. The percentage of patients who did not have a linked HES record varies by
cancer site from 27% for prostate cancer to 3% for oesophageal cancer. Table 1 shows the breakdown
by site and Appendix 1 shows the percentage of matched patients by cancer site and by cancer
network.
5
Table 1: Percentage of Non-DCO cancer registrations linked to a HES record, by cancer site, patients
diagnosed 2004-06, with HES up to 2007.
Cancer Site
oesophagus
stomach
liver
pancreas
colorectal
lung
breast
cervix
ovary
uterus
prostate
kidney
bladder
Number of NonDCO patients
18,458
18,771
6,732
17,490
85,513
87,703
110,808
6,765
15,852
16,880
87,874
17,649
24,508
Non-DCO
patients linked to
HES
17,839
17,830
6,056
16,074
80,690
80,522
97,690
6,007
14,444
15,374
63,940
16,314
23,562
Percent of
patients linked
to HES
97%
95%
90%
92%
94%
92%
88%
89%
91%
91%
73%
92%
96%
Summary of results
For all cancer sites, there was a decrease in the proportion of patients undergoing a major resection
for older patients, with less than 2% of patients aged 80+ having a record of a major resection for six
of the thirteen cancer sites analysed. There was evidence of small but significant decreases in the
proportion of patients receiving a major resection in the more deprived socio-economic groups and
also of variation in surgical rates between cancer networks. However, further work is required in order
to the better understand the clinical significance of these observations since other factors such as late
diagnosis (i.e. stage of disease) and co-morbidities could contribute to these differences.
For cancers of the oesophagus, stomach, bladder, prostate, lung, pancreas and liver, less than 16%
had a record of a major resection as part of their treatment. For liver cancer, only 6% of all patients
were recorded as having undergone a major resection within NHS hospitals. With the exception of
stomach cancer, less than 2% of patients aged over 80 had a record of a major resection in any of
these cancer sites.
Large falls in the percentage of patients with a record of a major resection by age were seen for
ovarian, kidney and cervical cancer. For patients aged 40-49 compared to patients aged 80+, the
proportion decreased from 82% to 26% for ovarian, from 78% to 29% for kidney and from 58% to
10% for cervical cancer.
The highest percentage of patients aged 80 and over with a record of a major resection was seen in
uterine cancer where a resection rate of 65% of NHS treated patients was seen.
Variation by deprivation quintile was not adjusted for age or other case-mix factors. Further work is
therefore required to examine whether there are particular sub-groups of patients where there are real
differences related to deprivation that may be hidden by this high level analysis.
6
The largest difference by deprivation quintile was seen for cervical cancer, with a gap of 10 percentage
points between the least deprived and the most deprived. This gap can be expressed as a change of
2.3 percentage points per deprivation quintile and was statistically significant. Further analyses are
required to try and define the reasons underlying this observation.
Differences in major surgery rates by deprivation quintile were also seen for cancers of the breast,
colorectal (males and females), liver (f), lung (m), oesophagus (m), pancreas (m) and prostate. The
differences however were relatively small for these sites, with the largest deprivation gap seen for
oesophageal cancer with a difference of 1.3 percentage points per deprivation quintile.
Not having access to data for patients treated in the private setting may also result in an
underestimation of the “deprivation gap” in major resections since private cancer surgery will be most
frequent in the least deprived socio-economic groups.
Results analysed by cancer network also show that variation exists between the areas of residence of
patients which cannot be explained by differences in the age structure of the populations. These
results are presented to encourage further local and national examination of the reasons behind these
apparent geographical differences in surgical resection rates. Only three of the sites, breast, uterus and
liver, had all cancer networks within limits of expected variation when differences in age structures
have been taken into account. For lung cancer, six cancer networks fell below the lower confidence
limit and four cancer networks were above the upper confidence limit. This first analysis simply shows
that variations do exist and should not, at this stage, be interpreted as necessarily demonstrating good
or bad practice.
Limitations
There are various factors which limit our ability to interpret these data. The most important of which is
that we have not been able to make case-mix adjustments of the surgical rates for the stage of disease
since this is not universally recorded for all cancer sites at a national level. There are surgical
procedures which it is not possible to assign as ‘major’ resections without knowing the stage of disease
for that patient. For early stage cervical patients, for example, operations which are coded as biopsies
would have been undertaken to remove the tumour, whereas for patients with later stage disease, this
would be a diagnostic procedure.
There are also concerns over the quality of data within HES which was not established with the direct
intention of analysing the details of surgical operations, rather as a tool for reimbursement. However, it
is a large scale and routinely available data source which we can use to try and gain a better
understanding of cancer patients’ treatment. It is possible that there is some systematic variation in the
way different Trusts code their procedures which could also explain some of the apparent variation at
Network level.
These analyses have also not taken into account co-morbidities of patients which will affect the
decision to treat and which could vary in their impact at regional level. The NCIN is committed to
further work on this topic which we hope will allow for the adjustment of such data for co-morbidity.
In order to use such data to understand differences in clinical outcomes for patients for the future, we
need to ensure that surgical procedures are coded consistently. It has become clear during the course
of this work that there is significant scope for the rationalisation of how surgical procedure codes are
used in this context and clinicians need to take more responsibility for how their activity is recorded.
7
Next steps
These data provide an overview of the available data that is held regarding major surgical resections in
England. However, this is just a basis to instigate an exploration of which questions need answering,
and how the data can be recorded and shared in order to allow further analyses to be made. The
results provide further evidence for the need for high quality cancer stage, co-morbidity and treatment
data in order to explore the reasons for any variation.
1) Derive Charlson Indices from IP HES to examine the impact of co-morbidity on the variation.
2) Work with the clinical community via the NCIN’s SSCRGs to engage with the coding section of
Connecting for Health to try and improve the way that surgical procedures in cancer are coded.
3) Carry out more in-depth analyses of the impact of deprivation on surgical rates.
4) Try and establish the relationship between surgical treatment rates and outcomes, especially
survival.
5) Make more systematic and ongoing links with the National Cancer Audits.
6) Try and find ways of examining the whole ‘treatment pathway’ for cancer patients; in other words,
examine the role of surgery in combination with other oncological treatments.
7) Use the data to help support module 5 of the International Cancer Benchmarking Project; working
towards internationally agreed ‘benchmarks’ of good practice.
8
Acknowledgements
This analysis was led by Jon Shelton. Thanks are due to Dr Mick Peake, Clinical Lead, NCIN and all the
Site-Specific Clinical Reference Group lead clinicians for their work in this project, especially the
involvement of Mr Bill Allum, Mr Andy Nordin, Mr Roger Kockelbergh, Prof. Paul Finan, and Mr Martin
Lee, who have played a prominent role in the thinking behind this report.
Thanks are also due to many members of lead cancer registries who have helped enable these
analyses, with thanks especially to Eva Morris, Gill Lawrence, Henrik Møller, Louise Hollingworth, David
Meechan, Alexandra Thackery, Elizabeth Davies, Victoria Coupland, Luke Hounsome, Sean McPhail
and David Greenberg.
Particular thanks are due to James Thomas (NYCRIS) for preparing and providing data from the
National Cancer Data Repository and to Carolynn Gildea (Trent Cancer Registry) for the time and effort
invested in helping with these analyses.
This project was conceived and initially led by David Forman (IARC, formerly of NYCRIS) and
supported by Catherine Thomson (Cancer Research UK) both of whose involvement has been
invaluable.
9
NHS treated patients with a record of a major resection, by sex, age and
deprivation quintile, 2004-2006, followed up to 2007
C15: Oesophagus
Of all newly diagnosed cases of oesophageal cancer registered in England in 2004-2006 (excluding Death Certificate Only registrations), 97% were linked to at least
one record within HES. The results presented on these pages show the percentage of these linked, non-DCO patients who had a record of a major resection as part of
their treatment.
Using OPCS-4 codes, operations that have been defined as major resections include oesophagectomy, and partial excisions of the oesophagus. The full list of OPCS4 codes used for oesophageal cancer are included in the appendix.
These results are intending to show any differences in the percentage of NHS treated patients with a record of a major resection by different equality groups; age, sex
and deprivation. However, caution should be taken when interpreting these results due to limitations in using HES data. These results do not show the proportion of
patients who are cured of their cancer through surgery, although it is believed that the large majority of these operations will have been carried out with curative intent.
In addition, the treatment of private patients will not be captured.
Major resections by age and sex
Male
HES linked
patients
Age group
% major
resections
79
472
1,893
3,140
3,675
2,333
11,592
Under 40
40-49
50-59
60-69
70-79
80+
All ages
100%
28%
28%
28%
25%
15%
2%
18%
Female
95% Confidence
Interval
19%
24%
26%
23%
14%
1%
17%
-
HES linked
patients
39%
32%
30%
26%
16%
2%
18%
% major
resections
27
165
606
1,154
1,942
2,353
6,247
33%
28%
27%
24%
11%
1%
12%
Persons
95% Confidence
Interval
19%
22%
23%
22%
9%
1%
11%
-
HES linked
patients
52%
35%
30%
27%
12%
2%
12%
% major
resections
106
637
2,499
4,294
5,617
4,686
17,839
29%
28%
28%
25%
13%
1%
16%
95% Confidence
Interval
21%
24%
26%
23%
12%
1%
15%
-
39%
31%
30%
26%
14%
2%
16%
Percentage of NHS treated patients with a record of a major resection for oesophageal cancer, by sex and age group
90%
Percentage
ge of patients
80%
70%
60%
Male
Female
50%
40%
30%
20%
10%
0%
Under 40
40‐49
50‐59
Age group
60‐69
70‐79
80+
Major resections by deprivation quintile and sex
Male
HES linked
patients
Deprivation quintile
2,064
2,503
2,465
2,403
2,157
11,592
Quintile 1 - least deprived
Quintile 2
Quintile 3
Quintile 4
Quintile 5 - most deprived
All quintiles
% major
resections
21%
18%
17%
16%
15%
18%
Female
95% Confidence
Interval
19%
17%
16%
15%
14%
17%
-
HES linked
patients
22%
20%
19%
18%
17%
18%
% major
resections
1,058
1,256
1,351
1,376
1,206
6,247
14%
12%
11%
10%
11%
12%
Persons
95% Confidence
Interval
12%
11%
10%
8%
10%
11%
-
HES linked
patients
16%
14%
13%
11%
13%
12%
% major
resections
3,122
3,759
3,816
3,779
3,363
17,839
18%
16%
15%
14%
14%
16%
95% Confidence
Interval
17%
15%
14%
13%
13%
15%
-
20%
18%
16%
15%
15%
16%
Quintile
100%
Percentage of NHS treated patients with a record of a major resection for oesophageal cancer, by deprivation quintile
90%
Percentage of patients
80%
70%
60%
Male
50%
Female
40%
30%
20%
10%
0%
Least Deprived
Quintile2
Quintile3
Quintile4
Most Deprived
England
Deprivation Quintile
The percentage of patients with a record of a major resection is similar for males and females within each age band. However, there was a higher rate for males in the
70-79 age band compared to females.
There is a decrease in the older age groups in the percentage of oesophageal cancer patients with a record of a major resection. In patients aged 60-69, 25% had a
record of a major resection compared to 13% of 70-79 year olds and 1% of patients aged 80 and over.
There was a decrease in the percentage of patients with a record of a major resection for males (-1.3% per quintile, p=0.002) by deprivation quintile that was
statistically significant. There was no statistically significant change for females. The percentages by deprivation quintile have not been adjusted for differences in the
age structure within each quintile
quintile.
10
NHS treated patients with a record of a major resection, by sex and cancer
network, 2004-2006 followed up to 2007
C15: Oesophagus
The results on this page are a reflection of the surgical treatment data currently available through HES, however, there are limitations in the data available and therefore
these results are being presented in order to stimulate further discussions with the clinical community as to what factors affect surgery rates and how we can improve
data collection. Differences between cancer networks maybe due to higher rates of private patients, later stage of disease at diagnosis, co-morbidities, miscoding or
poor data flow. It is important to read the introduction to this report to understand the limitations of data currently available nationally.
These results are observational; there is no "good" or "bad" percentage from these results. Better quality data are required in order to understand how surgery rates can
affect outcomes. The cancer network relates to the residence of the patient at diagnosis and not the hospital or trust where the patient was treated. Improved data
quality and consistency of coding will allow further research into inequalities in cancer to be undertaken to create a better understanding of how patients are treated
within the NHS and to target efforts to improve their outcomes.
Major resections by cancer network and sex
Male
HES linked
patients
Cancer network
405
796
560
603
326
450
403
234
178
222
231
234
267
256
506
197
492
268
515
454
252
338
393
445
700
547
341
979
11,592
N01 Lancashire and South Cumbria CN
N02 Greater Manchester and Cheshire CN
N03 Merseyside and Cheshire CN
N06 Yorkshire CN
N07 Humber and Yorkshire Coast CN
N08 North Trent CN
N11 Pan Birmingham CN
N12 Arden CN
N20 Mount Vernon CN
N21 West London CN
N22 North London CN
N23 North East London CN
N24 South East London CN
N25 South West London CN
N26 Peninsula CN
N27 Dorset CN
N28 Avon, Somerset and Wiltshire CN
N29 3 Counties CN
N30 Thames Valley CN
N31 Central South Coast CN
N32 Surrey, West Sussex and Hampshire CN
N33 Sussex CN
N34 Kent and Medway CN
N35 Greater Midlands CN
N36 North of England CN
N37 Anglia CN
N38 Essex CN
N39 East Midlands CN
England
% major
resections
17%
16%
19%
20%
23%
23%
18%
21%
14%
14%
12%
12%
14%
11%
23%
13%
15%
16%
20%
13%
15%
6%
15%
21%
16%
18%
14%
25%
18%
Female
95% Confidence
Interval
13%
14%
16%
17%
18%
19%
15%
16%
10%
10%
9%
8%
11%
8%
19%
9%
13%
12%
17%
10%
11%
4%
11%
18%
13%
15%
11%
22%
17%
-
HES linked
patients
21%
19%
23%
23%
28%
27%
22%
26%
20%
19%
17%
16%
19%
16%
26%
18%
19%
21%
24%
16%
20%
9%
18%
25%
19%
22%
18%
28%
18%
233
420
336
333
165
239
221
124
124
133
93
111
137
131
266
116
281
156
238
231
117
191
182
240
400
355
149
525
6,247
Percentage of NHS treated oesophageal cancer patients with a record of a major resection, by cancer network
30
11%
10%
18%
12%
17%
16%
17%
21%
11%
6%
5%
9%
6%
5%
11%
8%
7%
6%
14%
9%
7%
2%
7%
10%
11%
15%
10%
18%
12%
Persons
95% Confidence
Interval
7%
8%
15%
9%
12%
12%
13%
15%
7%
3%
2%
5%
3%
2%
7%
4%
5%
3%
10%
6%
4%
1%
4%
6%
8%
12%
6%
15%
11%
-
HES linked
patients
15%
14%
23%
16%
23%
22%
23%
29%
18%
11%
12%
16%
11%
10%
15%
14%
11%
11%
19%
13%
13%
5%
11%
14%
14%
20%
16%
22%
12%
638
1,216
896
936
491
689
624
358
302
355
324
345
404
387
772
313
773
424
753
685
369
529
575
685
1,100
902
490
1,504
17,839
Age-Standardised Ratio
10
Networks below 99.8% Confidence limit:
N22, N25, N31 & N33
1.6
12%
13%
17%
15%
17%
18%
15%
17%
10%
8%
7%
8%
9%
7%
16%
8%
10%
9%
16%
9%
9%
3%
10%
14%
12%
15%
10%
21%
15%
-
18%
16%
22%
20%
25%
24%
21%
25%
17%
15%
14%
14%
15%
12%
21%
15%
15%
15%
21%
14%
16%
7%
15%
20%
16%
20%
16%
25%
16%
1.4
1.2
1.0
0.8
0.6
0.4
Networks below 99.8% Confidence limit:
N25 & N33
0.2
0
15%
14%
19%
17%
21%
21%
18%
21%
13%
11%
10%
11%
11%
9%
18%
11%
12%
12%
18%
12%
12%
5%
12%
17%
14%
17%
13%
23%
16%
Networks above 99.8% Confidence limit:
N39
1.8
20
95% Confidence
Interval
% major
resections
Indirectly age-standardised ratio: actual number of NHS treated
oesophageal cancer patients with a record of a major resection
divided by the expected number, by cancer network
2.0
Networks above 99.8% Confidence limit:
N08 & N39
Percentage of patients
% major
resections
0.0
0
200
400
600
800
1000
1200
1400
0
1600
Cancer network
England average
50
100
150
200
250
Expected number of patients receiving a major resection
Number of HES linked patients
cancer network
99.8% confidence limits
99.8% confidence limit
The funnel plot of percentages shows that six cancer networks fall outside the 99.8% confidence limits and therefore have a statistically significant difference from the
average for England in the percentage of patients recorded as having a major resection. The funnel plot of age-standardised ratios shows that only three networks fall
outside the 99.8% confidence limits. We cannot exclude the possibility that poor quality data flowing into HES may account for some of the differences seen.
Note: It is important to examine the data for these networks more carefully and investigate further as to what factors other than age may underlie the apparent
differences including coding quality within HES.
The percentages shown in the table above do not take into account any factors such as differences in the age-distributions, co-morbidities or stage at diagnosis of
patients between cancer networks.
11
NHS treated patients with a record of a major resection, by sex, age and
deprivation quintile, 2004-2006, followed up to 2007
C16: Stomach
Of all newly diagnosed cases of stomach cancer registered in England in 2004-2006 (excluding Death Certificate Only registrations), 95% were linked to at least one
record within HES. The results presented on these pages show the percentage of these linked, non-DCO patients who had a record of a major resection as part of their
treatment.
Using OPCS-4 codes, operations that have been defined as major resections include total excision of stomach and partial excision of the stomach. The full list of
OPCS-4 codes used for stomach cancer are included in the appendix.
These results are intending to show any differences in the percentage of NHS treated patients with a record of a major resection by different equality groups; age, sex
and deprivation. However, caution should be taken when interpreting these results due to limitations in using HES data. These results do not show the proportion of
patients who are cured of their cancer through surgery, although it is believed that the large majority of these operations will have been carried out with curative intent.
In addition, the treatment of private patients will not be captured.
Major resections by age and sex
Male
HES linked
patients
Age group
% major
resections
120
398
1,204
2,681
4,380
2,941
11,724
Under 40
40-49
50-59
60-69
70-79
80+
All ages
100%
18%
16%
16%
18%
17%
9%
15%
Female
95% Confidence
Interval
12%
13%
14%
17%
16%
8%
14%
-
HES linked
patients
25%
20%
18%
20%
18%
10%
16%
% major
resections
119
223
431
1,076
1,878
2,379
6,106
24%
21%
19%
19%
20%
7%
15%
Persons
95% Confidence
Interval
17%
16%
16%
17%
18%
6%
14%
-
HES linked
patients
32%
27%
23%
21%
21%
8%
15%
% major
resections
239
621
1,635
3,757
6,258
5,320
17,830
21%
18%
17%
18%
18%
8%
15%
95% Confidence
Interval
16%
15%
15%
17%
17%
7%
14%
-
26%
21%
19%
19%
19%
9%
15%
Percentage of NHS treated patients with a record of a major resection for stomach cancer, by sex and age group
90%
Percentage
ge of patients
80%
70%
60%
Male
Female
50%
40%
30%
20%
10%
0%
Under 40
40‐49
50‐59
Age group
60‐69
70‐79
80+
Major resections by deprivation quintile and sex
Male
HES linked
patients
Deprivation quintile
1,891
2,259
2,411
2,592
2,571
11,724
Quintile 1 - least deprived
Quintile 2
Quintile 3
Quintile 4
Quintile 5 - most deprived
All quintiles
% major
resections
15%
15%
14%
15%
16%
15%
Female
95% Confidence
Interval
14%
14%
12%
14%
14%
14%
-
HES linked
patients
17%
17%
15%
17%
17%
16%
% major
resections
863
1,143
1,308
1,382
1,410
6,106
17%
13%
15%
14%
14%
15%
Persons
95% Confidence
Interval
15%
11%
13%
13%
13%
14%
-
HES linked
patients
20%
15%
17%
16%
16%
15%
% major
resections
2,754
3,402
3,719
3,974
3,981
17,830
16%
15%
14%
15%
15%
15%
95% Confidence
Interval
15%
13%
13%
14%
14%
14%
-
17%
16%
15%
16%
16%
15%
Quintile
100%
Percentage of NHS treated patients with a record of a major resection for stomach cancer, by deprivation quintile
90%
Percentage of patients
80%
70%
60%
Male
50%
Female
40%
30%
20%
10%
0%
Least Deprived
Quintile2
Quintile3
Quintile4
Most Deprived
England
Deprivation Quintile
The difference in the percentage of patients with a record of a major resection between males and females within each age band is not statistically significant.
In patients aged under 80, around 18% had a record of a major resection. Across age bands for these patients, the difference in the percentage of patients with a
record of a major resection was not statistically significant. The rate dropped for patients aged 80 and over to 8%.
Across deprivation quintiles, there was no statistically significant change in the percentage of patients with a record of a major resection for either males or females.
The percentages by deprivation quintile have not been adjusted for differences in the age structure in each quintile.
12
NHS treated patients with a record of a major resection, by sex and cancer
network, 2004-2006 followed up to 2007
C16: Stomach
The results on this page are a reflection of the surgical treatment data currently available through HES, however, there are limitations in the data available and therefore
these results are being presented in order to stimulate further discussions with the clinical community as to what factors affect surgery rates and how we can improve
data collection. Differences between cancer networks maybe due to higher rates of private patients, later stage of disease at diagnosis, co-morbidities, miscoding or
poor data flow. It is important to read the introduction to this report to understand the limitations of data currently available nationally.
These results are observational; there is no "good" or "bad" percentage from these results. Better quality data are required in order to understand how surgery rates can
affect outcomes. The cancer network relates to the residence of the patient at diagnosis and not the hospital or trust where the patient was treated. Improved data
quality and consistency of coding will allow further research into inequalities in cancer to be undertaken to create a better understanding of how patients are treated
within the NHS and to target efforts to improve their outcomes.
Major resections by cancer network and sex
Male
HES linked
patients
Cancer network
N01 Lancashire and South Cumbria CN
N02 Greater Manchester and Cheshire CN
N03 Merseyside and Cheshire CN
N06 Yorkshire CN
N07 Humber and Yorkshire Coast CN
N08 North Trent CN
N11 Pan Birmingham CN
N12 Arden CN
N20 Mount Vernon CN
N21 West London CN
N22 North London CN
N23 North East London CN
N24 South East London CN
N25 South West London CN
N26 Peninsula CN
N27 Dorset CN
N28 Avon, Somerset and Wiltshire CN
N29 3 Counties CN
N30 Thames Valley CN
N31 Central South Coast CN
N32 Surrey, West Sussex and Hampshire CN
N33 Sussex CN
N34 Kent and Medway CN
N35 Greater Midlands CN
N36 North of England CN
N37 Anglia CN
N38 Essex CN
N39 East Midlands CN
England
% major
resections
344
845
600
599
299
581
511
215
204
251
197
298
272
254
401
190
365
214
376
409
184
211
338
566
979
736
285
1,000
11,724
14%
16%
16%
19%
17%
20%
10%
12%
20%
18%
17%
16%
10%
6%
12%
6%
11%
25%
11%
12%
11%
9%
15%
14%
19%
13%
11%
20%
15%
Female
95% Confidence
Interval
11%
14%
13%
16%
13%
17%
7%
8%
15%
14%
12%
12%
7%
3%
9%
4%
8%
19%
9%
9%
7%
6%
12%
11%
17%
11%
8%
17%
14%
-
HES linked
patients
18%
19%
19%
22%
22%
23%
12%
17%
26%
23%
23%
20%
14%
9%
15%
11%
15%
31%
15%
15%
16%
14%
20%
17%
22%
16%
15%
22%
16%
190
465
309
360
165
319
247
110
113
140
150
162
148
126
201
94
226
103
174
177
109
117
163
280
568
290
148
452
6,106
Percentage of NHS treated stomach cancer patients with a record of a major resection, by cancer network
30
21%
18%
15%
16%
14%
17%
10%
8%
19%
19%
12%
12%
10%
11%
11%
5%
10%
17%
10%
13%
12%
14%
12%
13%
17%
16%
15%
17%
15%
Persons
95% Confidence
Interval
15%
15%
11%
12%
9%
13%
7%
4%
13%
13%
8%
8%
6%
7%
7%
2%
7%
11%
7%
9%
7%
9%
8%
9%
14%
12%
10%
14%
14%
-
HES linked
patients
27%
22%
19%
20%
20%
22%
14%
15%
28%
26%
18%
18%
16%
18%
16%
12%
15%
26%
16%
19%
19%
21%
18%
17%
21%
21%
21%
21%
15%
534
1,310
909
959
464
900
758
325
317
391
347
460
420
380
602
284
591
317
550
586
293
328
501
846
1,547
1,026
433
1,452
17,830
Age-Standardised Ratio
10
Networks below 99.8% Confidence limit:
N11, N24, N25, N27 & N28
16%
17%
15%
18%
16%
19%
10%
10%
20%
18%
15%
15%
10%
7%
11%
6%
11%
22%
11%
12%
11%
11%
14%
13%
18%
14%
12%
19%
15%
14%
15%
13%
15%
13%
16%
8%
8%
16%
15%
11%
12%
7%
5%
9%
4%
9%
18%
9%
10%
8%
8%
12%
11%
17%
12%
9%
17%
14%
-
20%
19%
18%
20%
20%
22%
12%
14%
24%
22%
19%
18%
13%
10%
14%
9%
14%
27%
14%
15%
15%
15%
18%
16%
20%
16%
16%
21%
15%
Networks above 99.8% Confidence limit:
N36 & N39
1.8
20
95% Confidence
Interval
% major
resections
Indirectly age-standardised ratio: actual number of NHS treated
stomach cancer patients with a record of a major resection
divided by the expected number, by cancer network
2.0
Networks above 99.8% Confidence limit:
N29, N36 & N39
Percentage of patients
% major
resections
1.6
1.4
1.2
1.0
0.8
0.6
Networks below 99.8% Confidence limit:
N11, N25 & N27
0.4
0.2
0.0
0
0
200
400
600
800
1000
1200
1400
0
1600
England average
100
150
200
250
Expected number of patients receiving a major resection
Number of HES linked patients
Cancer network
50
cancer network
99.8% confidence limits
99.8% confidence limit
The funnel plot of percentages shows that eight cancer networks fall outside the 99.8% confidence limits and therefore have a statistically significant difference from the
average for England in the percentage of patients recorded with a major resection. The funnel plot of age-standardised ratios between observed and expected number
of patients with a record of a major resection only shows that five cancer networks fall outside the 99.8% confidence limits. We cannot exclude the possibility that poor
quality data flowing into HES may also account for some of the differences seen.
Note: It is important to examine the data for these networks more carefully and investigate further as to what other factors may underlie the apparent differences
including coding quality within HES. The percentages shown in the table above do not take into account any factors such as differences in the age-distributions, comorbidities or stage at diagnosis of patients between cancer networks.
13
NHS treated patients with a record of a major resection, by sex, age and
deprivation quintile, 2004-2006, followed up to 2007
C22: Liver
Of all newly diagnosed cases of liver cancer registered in England in 2004-2006 (excluding Death Certificate Only registrations), 90% were linked to at least one record
within HES. The results presented on these pages show the percentage of these linked, non-DCO patients who had a record of a major resection as part of their
treatment.
Using OPCS-4 codes, operations that have been defined as major resections are those classified under partial excisions of the liver. The full list of OPCS-4 codes used
for liver cancer are included in the appendix.
These results are intending to show any differences in the percentage of NHS treated patients with a record of a major resection by different equality groups; age, sex
and deprivation. However, caution should be taken when interpreting these results due to limitations in using HES data. These results do not show the proportion of
patients who are cured of their cancer through surgery, although it is believed that the large majority of these operations will have been carried out with curative intent.
In addition, the treatment of private patients will not be captured.
Major resections by age and sex
Male
HES linked
patients
Age group
% major
resections
108
190
544
951
1,256
707
3,756
Under 40
40-49
50-59
60-69
70-79
80+
All ages
100%
26%
6%
8%
7%
4%
1%
6%
Female
95% Confidence
Interval
19%
4%
6%
5%
3%
1%
5%
-
HES linked
patients
35%
11%
11%
9%
5%
2%
6%
% major
resections
69
97
251
459
697
727
2,300
32%
20%
12%
9%
5%
1%
7%
Persons
95% Confidence
Interval
22%
13%
9%
7%
3%
0%
6%
-
HES linked
patients
44%
29%
17%
12%
6%
2%
8%
% major
resections
177
287
795
1,410
1,953
1,434
6,056
28%
11%
10%
8%
4%
1%
6%
95% Confidence
Interval
22%
8%
8%
6%
3%
1%
5%
-
35%
15%
12%
9%
5%
2%
7%
Percentage of NHS treated patients with a record of a major resection for liver cancer, by sex and age group
90%
Percentage
ge of patients
80%
70%
60%
Male
Female
50%
40%
30%
20%
10%
0%
Under 40
40‐49
50‐59
Age group
60‐69
70‐79
80+
Major resections by deprivation quintile and sex
Male
HES linked
patients
Deprivation quintile
654
703
736
777
886
3,756
Quintile 1 - least deprived
Quintile 2
Quintile 3
Quintile 4
Quintile 5 - most deprived
All quintiles
% major
resections
8%
5%
6%
5%
5%
6%
Female
95% Confidence
Interval
6%
3%
4%
4%
4%
5%
-
HES linked
patients
10%
7%
7%
7%
6%
6%
% major
resections
378
420
492
501
509
2,300
8%
8%
6%
6%
5%
7%
Persons
95% Confidence
Interval
6%
5%
4%
4%
4%
6%
-
HES linked
patients
11%
11%
9%
9%
8%
8%
% major
resections
1,032
1,123
1,228
1,278
1,395
6,056
8%
6%
6%
6%
5%
6%
95% Confidence
Interval
6%
5%
5%
5%
4%
5%
-
10%
7%
7%
7%
6%
7%
Quintile
100%
Percentage of NHS treated patients with a record of a major resection for liver cancer, by deprivation quintile
90%
Percentage of patients
80%
70%
60%
Male
50%
Female
40%
30%
20%
10%
0%
Least Deprived
Quintile2
Quintile3
Quintile4
Most Deprived
England
Deprivation Quintile
The percentage of patients aged 50 and over with a record of a major resection is similar for males and females within each age band. However, there was a higher
rate for females in the 40-49 age band compared to males.
There is a decrease in the older age groups in the percentage of liver cancer patients with a record of a major resection. In patients aged 60-69, 8% have a record of a
major resection compared to 4% of 70-79 year olds and 1% of patients aged 80 and over.
Across deprivation quintiles, there was no statistically significant change in the percentage of patients with a record of a major resection for males, however for females,
there was a decrease which was statistically significant (-0.71% per quintile, p=0.011). The percentages by deprivation quintile have not been adjusted for differences in
the age structure.
structure
14
NHS treated patients with a record of a major resection, by sex and cancer
network, 2004-2006 followed up to 2007
C22: Liver
The results on this page are a reflection of the surgical treatment data currently available through HES, however, there are limitations in the data available and therefore
these results are being presented in order to stimulate further discussions with the clinical community as to what factors affect surgery rates and how we can improve
data collection. Differences between cancer networks maybe due to higher rates of private patients, later stage of disease at diagnosis, co-morbidities, miscoding or
poor data flow. It is important to read the introduction to this report to understand the limitations of data currently available nationally.
These results are observational; there is no "good" or "bad" percentage from these results. Better quality data are required in order to understand how surgery rates can
affect outcomes. The cancer network relates to the residence of the patient at diagnosis and not the hospital or trust where the patient was treated. Improved data
quality and consistency of coding will allow further research into inequalities in cancer to be undertaken to create a better understanding of how patients are treated
within the NHS and to target efforts to improve their outcomes.
Major resections by cancer network and sex
Male
HES linked
patients
Cancer network
N01 Lancashire and South Cumbria CN
N02 Greater Manchester and Cheshire CN
N03 Merseyside and Cheshire CN
N06 Yorkshire CN
N07 Humber and Yorkshire Coast CN
N08 North Trent CN
N11 Pan Birmingham CN
N12 Arden CN
N20 Mount Vernon CN
N21 West London CN
N22 North London CN
N23 North East London CN
N24 South East London CN
N25 South West London CN
N26 Peninsula CN
N27 Dorset CN
N28 Avon, Somerset and Wiltshire CN
N29 3 Counties CN
N30 Thames Valley CN
N31 Central South Coast CN
N32 Surrey, West Sussex and Hampshire CN
N33 Sussex CN
N34 Kent and Medway CN
N35 Greater Midlands CN
N36 North of England CN
N37 Anglia CN
N38 Essex CN
N39 East Midlands CN
England
% major
resections
132
297
172
225
68
145
110
34
67
134
110
117
119
96
157
93
144
67
135
162
68
85
82
105
280
189
76
287
3,756
6%
5%
4%
11%
4%
8%
6%
9%
4%
9%
5%
3%
2%
5%
3%
3%
4%
1%
4%
5%
6%
4%
5%
4%
4%
6%
5%
9%
6%
Female
95% Confidence
Interval
3%
3%
2%
8%
2%
5%
3%
3%
2%
5%
3%
1%
0%
2%
1%
1%
2%
0%
2%
3%
2%
1%
2%
1%
2%
4%
2%
6%
5%
-
HES linked
patients
12%
9%
8%
16%
12%
14%
13%
23%
12%
15%
11%
8%
6%
12%
7%
9%
9%
8%
9%
9%
14%
10%
12%
9%
7%
11%
13%
13%
6%
90
208
118
136
68
94
60
31
39
66
61
74
47
51
77
49
104
40
81
84
44
58
51
66
170
99
46
188
2,300
Percentage of NHS treated liver cancer patients with a record of a major resection, by cancer network
14
Age-Standardised Ratio
10
Percentage of patients
(numbers shown are %)
6%
5%
6%
7%
6%
3%
7%
6%
3%
3%
7%
0%
9%
6%
8%
10%
6%
15%
4%
12%
14%
5%
6%
8%
6%
7%
9%
10%
7%
8
6
Persons
95% Confidence
Interval
2%
3%
3%
4%
2%
1%
3%
2%
0%
1%
3%
0%
3%
2%
4%
4%
3%
7%
1%
7%
6%
2%
2%
3%
3%
3%
3%
6%
6%
-
HES linked
patients
12%
9%
12%
12%
14%
9%
16%
21%
13%
10%
16%
5%
20%
16%
16%
22%
12%
29%
10%
21%
27%
14%
16%
17%
10%
14%
20%
15%
8%
222
505
290
361
136
239
170
65
106
200
171
191
166
147
234
142
248
107
216
246
112
143
133
171
450
288
122
475
6,056
% major
resections
6%
5%
5%
9%
5%
6%
6%
8%
4%
7%
6%
2%
4%
5%
5%
6%
5%
7%
4%
7%
9%
4%
5%
5%
5%
7%
7%
9%
6%
95% Confidence
Interval
3%
4%
3%
7%
3%
4%
4%
3%
1%
4%
3%
1%
2%
3%
3%
3%
3%
3%
2%
5%
5%
2%
3%
3%
3%
4%
3%
7%
5%
-
10%
8%
8%
13%
10%
10%
11%
17%
9%
11%
10%
5%
8%
10%
8%
11%
8%
13%
8%
11%
16%
9%
10%
10%
7%
10%
12%
12%
7%
Indirectly age-standardised ratio: actual number of NHS treated
liver cancer patients with a record of a major resection divided by
the expected number, by cancer network
2.5
Networks above 99.8% Confidence limit:
None
12
% major
resections
Networks above 99.8% Confidence limit:
None
2.0
1.5
1.0
4
0.5
Networks below 99.8% Confidence limit:
N23
2
Networks below 99.8% Confidence limit:
None
0
0.0
0
100
200
300
400
0
500
England average
10
15
20
25
30
35
Expected number of patients receiving a major resection
Number of HES linked patients
Cancer network
5
cancer network
99.8% confidence limits
99.8% confidence limit
The funnel plot of percentages show that the majority of cancer networks fall within the 99.8% confidence limits and therefore do not have a statistically significant
difference from the average for England in the percentage of patients recorded as having a major resection. The funnel plot of age-standardised ratios shows that all
cancer networks fall between the 99.8% confidence limits.
Note: The percentages shown in the table above do not take into account any factors such as differences in the age-distributions, co-morbidities or stage at diagnosis
of patients between cancer networks.
15
NHS treated patients with a record of a major resection, by sex, age and
deprivation quintile, 2004-2006, followed up to 2007
C25: Pancreas
Of all newly diagnosed cases of pancreatic cancer registered in England in 2004-2006 (excluding Death Certificate Only registrations), 92% were linked to at least one
record within HES. The results presented on these pages show the percentage of these linked, non-DCO patients who had a record of a major resection as part of their
treatment.
Using OPCS-4 codes, operations that have been defined as major resections include total excision of the pancreas, excision of head of pancreas and partial excision of
the pancreas. The full list of OPCS-4 codes used for pancreatic cancer are included in the appendix.
These results are intending to show any differences in the percentage of NHS treated patients with a record of a major resection by different equality groups; age, sex
and deprivation. However, caution should be taken when interpreting these results due to limitations in using HES data. These results do not show the proportion of
patients who are cured of their cancer through surgery, although it is believed that the large majority of these operations will have been carried out with curative intent.
In addition, the treatment of private patients will not be captured.
Major resections by age and sex
Male
HES linked
patients
Age group
% major
resections
70
295
1,149
2,131
2,613
1,660
7,918
Under 40
40-49
50-59
60-69
70-79
80+
All ages
100%
14%
14%
13%
13%
8%
1%
9%
Female
95% Confidence
Interval
8%
10%
11%
11%
7%
1%
8%
-
HES linked
patients
24%
18%
15%
14%
9%
1%
9%
% major
resections
71
227
890
1,781
2,555
2,632
8,156
32%
24%
14%
12%
7%
1%
7%
Persons
95% Confidence
Interval
23%
19%
12%
10%
6%
0%
7%
-
HES linked
patients
44%
30%
17%
13%
8%
1%
8%
% major
resections
141
522
2,039
3,912
5,168
4,292
16,074
23%
18%
13%
12%
7%
1%
8%
95% Confidence
Interval
17%
15%
12%
11%
7%
1%
8%
-
31%
22%
15%
13%
8%
1%
8%
Percentage of NHS treated patients with a record of a major resection for pancreatic cancer, by sex and age group
90%
Percentage
ge of patients
80%
70%
60%
Male
Female
50%
40%
30%
20%
10%
0%
Under 40
40‐49
50‐59
Age group
60‐69
70‐79
80+
Major resections by deprivation quintile and sex
Male
HES linked
patients
Deprivation quintile
1,562
1,747
1,691
1,580
1,338
7,918
Quintile 1 - least deprived
Quintile 2
Quintile 3
Quintile 4
Quintile 5 - most deprived
All quintiles
% major
resections
9%
9%
8%
8%
8%
9%
Female
95% Confidence
Interval
8%
8%
7%
7%
7%
8%
-
HES linked
patients
11%
11%
10%
9%
10%
9%
% major
resections
1,465
1,757
1,745
1,732
1,457
8,156
8%
8%
6%
7%
7%
7%
Persons
95% Confidence
Interval
7%
7%
5%
6%
6%
7%
-
HES linked
patients
10%
10%
8%
8%
8%
8%
% major
resections
3,027
3,504
3,436
3,312
2,795
16,074
9%
9%
7%
7%
7%
8%
95% Confidence
Interval
8%
8%
7%
6%
6%
8%
-
10%
10%
8%
8%
8%
8%
Quintile
100%
Percentage of NHS treated patients with a record of a major resection for pancreatic cancer, by deprivation quintile
90%
Percentage of patients
80%
70%
60%
Male
50%
Female
40%
30%
20%
10%
0%
Least Deprived
Quintile2
Quintile3
Quintile4
Most Deprived
England
Deprivation Quintile
The difference in the percentage of patients with a record of a major resection between males and females within each age band is not statistically significant above the
age of 50.
There is a decrease in the older age groups in the percentage of pancreatic cancer patients with a record of a major resection. In patients aged 60-69, 12% had a
record of a major resection compared to 7% of 70-79 year olds and 1% of patients aged 80 and over.
There was a decrease in the percentage of patients with a record of a major resection for males (-0.5% per quintile, p=0.04) by deprivation quintile that was statistically
significant. There was no statistically significant change for females. The percentages by deprivation quintile have not been adjusted for differences in the age structure.
16
NHS treated patients with a record of a major resection, by sex and cancer
network, 2004-2006 followed up to 2007
C25: Pancreas
The results on this page are a reflection of the surgical treatment data currently available through HES, however, there are limitations in the data available and therefore
these results are being presented in order to stimulate further discussions with the clinical community as to what factors affect surgery rates and how we can improve
data collection. Differences between cancer networks maybe due to higher rates of private patients, later stage of disease at diagnosis, co-morbidities, miscoding or
poor data flow. It is important to read the introduction to this report to understand the limitations of data currently available nationally.
These results are observational; there is no "good" or "bad" percentage from these results. Better quality data are required in order to understand how surgery rates can
affect outcomes. The cancer network relates to the residence of the patient at diagnosis and not the hospital or trust where the patient was treated. Improved data
quality and consistency of coding will allow further research into inequalities in cancer to be undertaken to create a better understanding of how patients are treated
within the NHS and to target efforts to improve their outcomes.
Major resections by cancer network and sex
Male
HES linked
patients
Cancer network
250
431
310
394
180
311
206
102
157
194
180
219
206
217
332
145
300
188
346
328
177
196
259
255
547
506
239
743
7,918
N01 Lancashire and South Cumbria CN
N02 Greater Manchester and Cheshire CN
N03 Merseyside and Cheshire CN
N06 Yorkshire CN
N07 Humber and Yorkshire Coast CN
N08 North Trent CN
N11 Pan Birmingham CN
N12 Arden CN
N20 Mount Vernon CN
N21 West London CN
N22 North London CN
N23 North East London CN
N24 South East London CN
N25 South West London CN
N26 Peninsula CN
N27 Dorset CN
N28 Avon, Somerset and Wiltshire CN
N29 3 Counties CN
N30 Thames Valley CN
N31 Central South Coast CN
N32 Surrey, West Sussex and Hampshire CN
N33 Sussex CN
N34 Kent and Medway CN
N35 Greater Midlands CN
N36 North of England CN
N37 Anglia CN
N38 Essex CN
N39 East Midlands CN
England
% major
resections
10%
8%
10%
10%
9%
7%
18%
10%
7%
12%
7%
4%
13%
7%
7%
3%
4%
9%
9%
12%
8%
5%
8%
10%
11%
8%
5%
8%
9%
Female
95% Confidence
Interval
7%
6%
7%
7%
6%
4%
13%
5%
4%
8%
4%
2%
9%
4%
5%
1%
3%
5%
6%
9%
5%
2%
5%
7%
9%
6%
3%
6%
8%
-
HES linked
patients
14%
11%
13%
13%
14%
10%
24%
17%
12%
18%
12%
8%
18%
11%
11%
8%
7%
13%
12%
16%
14%
8%
12%
14%
14%
11%
8%
10%
9%
255
479
354
388
193
326
216
106
138
181
198
224
197
215
346
182
356
181
330
400
187
223
251
215
588
520
239
668
8,156
Percentage of NHS treated pancreatic cancer patients with a record of a major resection, by cancer network
20
5%
6%
5%
5%
3%
6%
11%
10%
2%
5%
6%
3%
5%
3%
3%
2%
4%
3%
5%
8%
5%
2%
3%
7%
5%
5%
4%
6%
7%
-
HES linked
patients
12%
11%
11%
10%
10%
12%
21%
24%
8%
13%
14%
9%
12%
10%
8%
8%
9%
10%
11%
14%
12%
7%
8%
15%
10%
9%
10%
10%
8%
505
910
664
782
373
637
422
208
295
375
378
443
403
432
678
327
656
369
676
728
364
419
510
470
1,135
1,026
478
1,411
16,074
10
Networks below 99.8% Confidence limit:
N23, N27, N28 & N33
95% Confidence
Interval
9%
8%
8%
9%
7%
8%
17%
13%
5%
10%
8%
5%
10%
6%
6%
4%
5%
7%
8%
11%
8%
4%
6%
10%
9%
7%
5%
8%
8%
7%
7%
7%
7%
5%
6%
13%
9%
3%
7%
6%
3%
8%
4%
5%
2%
4%
5%
6%
9%
6%
3%
4%
8%
8%
6%
4%
7%
8%
-
12%
10%
11%
11%
10%
10%
20%
18%
9%
14%
11%
7%
14%
9%
8%
6%
7%
10%
11%
14%
11%
6%
9%
13%
11%
9%
8%
10%
8%
Networks above 99.8% Confidence limit:
N11
2.0
1.5
1.0
Networks below 99.8% Confidence limit:
N27 & N33
0.5
0
% major
resections
Indirectly age-standardised ratio: actual number of NHS treated
pancreatic cancer patients with a record of a major resection
divided by the expected number, by cancer network
2.5
Age-Standardised Ratio
Percentage of patients
8%
8%
7%
7%
6%
8%
15%
16%
4%
8%
9%
5%
8%
6%
5%
4%
6%
6%
8%
11%
7%
4%
5%
10%
7%
7%
6%
8%
7%
3.0
Networks above 99.8% Confidence limit:
N11
Persons
95% Confidence
Interval
% major
resections
0.0
0
200
400
600
800
1000
1200
0
1400
Cancer network
England average
20
40
60
80
100
120
Expected number of patients receiving a major resection
Number of HES linked patients
99.8% confidence limits
cancer network
99.8% confidence limit
The funnel plot of cancer network percentages shows that the majority of cancer networks fall within the 99.8% confidence limits and therefore do not have a
statistically significant difference from the average for England in the percentage of patients recorded as having a major resection. However, the percentages for five
cancer networks do fall outside the confidence limits. The funnel plot of age-standardised ratios between observed and expected number of patients with a record of a
major resection shows that three cancer networks fall outside the 99.8% confidence limits. We cannot exclude the possibility that poor quality data flowing into HES
may account for some of the differences seen.
Note: It is important to examine the data for these networks more carefully and investigate further as to what other factors may underlie the apparent differences
including coding quality within HES. The percentages shown in the table above do not take into account any factors such as differences in the age-distributions, comorbidities or stage at diagnosis of patients between cancer networks.
17
NHS treated patients with a record of a major resection, by sex, age and
deprivation quintile, 2004-2006, followed up to 2007
C18-20: Colorectal
Of all newly diagnosed cases of colorectal cancer registered in England in 2004-2006 (excluding Death Certificate Only registrations), 94% were linked to at least one
record within HES. The results presented on these pages show the percentage of these linked, non-DCO patients who had a record of a major resection as part of their
treatment.
Using OPCS-4 codes, operations such as hemicoloectomy, total colectomy and total excision of colon were included as major resections. The full list of OPCS-4 codes
used for colorectal cancer are included in the appendix.
These results are intending to show any differences in the percentage of NHS treated patients with a record of a major resection by different equality groups; age, sex
and deprivation. However, caution should be taken when interpreting these results due to limitations in using HES data. These results do not show the proportion of
patients who are cured of their cancer through surgery, although it is believed that the large majority of these operations will have been carried out with curative intent.
In addition, the treatment of private patients will not be captured.
Major resections by age and sex
Male
HES linked
patients
Age group
% major
resections
565
1,640
5,684
11,572
15,772
9,630
44,863
Under 40
40-49
50-59
60-69
70-79
80+
All ages
100%
68%
65%
68%
70%
69%
56%
66%
Female
95% Confidence
Interval
64%
63%
67%
69%
68%
55%
66%
-
HES linked
patients
72%
68%
69%
71%
70%
57%
67%
% major
resections
514
1,407
3,933
7,250
11,505
11,218
35,827
69%
71%
73%
74%
71%
55%
67%
Persons
95% Confidence
Interval
65%
68%
72%
73%
70%
54%
66%
-
HES linked
patients
73%
73%
74%
75%
72%
56%
67%
% major
resections
1,079
3,047
9,617
18,822
27,277
20,848
80,690
68%
68%
70%
71%
70%
55%
66%
95% Confidence
Interval
66%
66%
69%
71%
69%
55%
66%
-
71%
69%
71%
72%
70%
56%
67%
Percentage of NHS treated patients with a record of a major resection for colorectal cancer, by sex and age group
90%
Percentage
ge of patients
80%
70%
60%
Male
Female
50%
40%
30%
20%
10%
0%
Under 40
40‐49
50‐59
Age group
60‐69
70‐79
80+
Major resections by deprivation quintile and sex
Male
HES linked
patients
Deprivation quintile
9,082
9,829
9,512
8,778
7,662
44,863
Quintile 1 - least deprived
Quintile 2
Quintile 3
Quintile 4
Quintile 5 - most deprived
All quintiles
% major
resections
68%
68%
66%
65%
64%
66%
Female
95% Confidence
Interval
67%
67%
65%
64%
63%
66%
-
HES linked
patients
69%
69%
67%
66%
65%
67%
% major
resections
6,925
7,809
7,801
7,360
5,932
35,827
68%
67%
67%
66%
64%
67%
Persons
95% Confidence
Interval
67%
66%
66%
65%
63%
66%
-
HES linked
patients
69%
68%
68%
67%
65%
67%
% major
resections
16,007
17,638
17,313
16,138
13,594
80,690
68%
68%
67%
66%
64%
66%
95% Confidence
Interval
67%
67%
66%
65%
63%
66%
-
69%
68%
67%
66%
65%
67%
Quintile
100%
Percentage of NHS treated patients with a record of a major resection for colorectal cancer, by deprivation quintile
90%
Percentage of patients
80%
70%
60%
Male
50%
Female
40%
30%
20%
10%
0%
Least Deprived
Quintile2
Quintile3
Quintile4
Most Deprived
England
Deprivation Quintile
The percentage of patients with a record of a major resection is higher for females compared to males for patients in each ten year age group between 40 and 79.
However, there was no difference in the percentage for patients aged 80 and over.
The percentage receiving a major resection is similar for all age groups. However, for patients aged 80 and over, the percentage falls to 55%, compared to around 70%
for all other age groups.
Across the deprivation quintiles, there was a decrease in the percentage of patients with a record of a major resection for both males (-1.1% per quintile, p=0.02) and
females (-1.0% per quintile, p=0.029) by deprivation quintile that was statistically significant . The percentages by deprivation quintile have not been adjusted for
differences in the age structure
structure.
18
NHS treated patients with a record of a major resection, by sex and cancer
network, 2004-2006 followed up to 2007
C18-20: Colorectal
The results on this page are a reflection of the surgical treatment data currently available through HES, however, there are limitations in the data available and therefore
these results are being presented in order to stimulate further discussions with the clinical community as to what factors affect surgery rates and how we can improve
data collection. Differences between cancer networks maybe due to higher rates of private patients, later stage of disease at diagnosis, co-morbidities, miscoding or
poor data flow. It is important to read the introduction to this report to understand the limitations of data currently available nationally.
These results are observational; there is no "good" or "bad" percentage from these results. Better quality data are required in order to understand how surgery rates can
affect outcomes. The cancer network relates to the residence of the patient at diagnosis and not the hospital or trust where the patient was treated. Improved data
quality and consistency of coding will allow further research into inequalities in cancer to be undertaken to create a better understanding of how patients are treated
within the NHS and to target efforts to improve their outcomes.
Major resections by cancer network and sex
Male
HES linked
patients
Cancer network
1,476
2,748
1,958
2,293
1,099
1,765
1,613
836
853
935
919
848
950
1,052
1,880
834
1,851
1,111
1,857
1,858
870
1,027
1,323
1,828
3,342
2,728
1,214
3,795
44,863
N01 Lancashire and South Cumbria CN
N02 Greater Manchester and Cheshire CN
N03 Merseyside and Cheshire CN
N06 Yorkshire CN
N07 Humber and Yorkshire Coast CN
N08 North Trent CN
N11 Pan Birmingham CN
N12 Arden CN
N20 Mount Vernon CN
N21 West London CN
N22 North London CN
N23 North East London CN
N24 South East London CN
N25 South West London CN
N26 Peninsula CN
N27 Dorset CN
N28 Avon, Somerset and Wiltshire CN
N29 3 Counties CN
N30 Thames Valley CN
N31 Central South Coast CN
N32 Surrey, West Sussex and Hampshire CN
N33 Sussex CN
N34 Kent and Medway CN
N35 Greater Midlands CN
N36 North of England CN
N37 Anglia CN
N38 Essex CN
N39 East Midlands CN
England
66%
67%
69%
66%
70%
63%
70%
68%
63%
65%
64%
59%
59%
60%
67%
61%
66%
73%
63%
68%
65%
63%
60%
71%
67%
71%
67%
65%
66%
Female
95% Confidence
Interval
64%
65%
67%
65%
67%
61%
68%
65%
60%
62%
61%
56%
56%
57%
65%
58%
64%
70%
61%
66%
62%
60%
58%
69%
66%
69%
64%
63%
66%
-
HES linked
patients
68%
69%
71%
68%
73%
65%
72%
71%
66%
68%
67%
62%
62%
63%
69%
64%
69%
75%
65%
70%
68%
66%
63%
73%
69%
72%
69%
66%
67%
Persons
95% Confidence
Interval
59%
64%
65%
65%
64%
61%
70%
70%
63%
64%
62%
56%
54%
56%
67%
64%
63%
71%
62%
64%
61%
61%
60%
70%
65%
70%
64%
64%
66%
-
HES linked
patients
65%
68%
70%
69%
70%
66%
75%
77%
70%
70%
69%
63%
61%
62%
72%
70%
68%
77%
67%
69%
68%
67%
66%
75%
69%
74%
69%
67%
67%
2,611
4,814
3,324
4,095
1,974
3,106
2,754
1,452
1,573
1,767
1,649
1,574
1,725
2,030
3,435
1,602
3,401
1,972
3,329
3,488
1,670
2,046
2,426
3,196
5,846
4,942
2,248
6,641
80,690
Age-Standardised Ratio
65
60
Networks below 99.8% Confidence limit:
N08, N23, N24, N25 & N34
64%
66%
69%
67%
69%
63%
71%
70%
65%
66%
65%
59%
58%
59%
68%
64%
66%
73%
64%
67%
65%
64%
61%
72%
67%
71%
67%
65%
66%
62%
65%
67%
65%
67%
61%
70%
68%
62%
64%
62%
57%
56%
57%
67%
61%
64%
71%
62%
66%
63%
61%
60%
70%
66%
70%
65%
64%
66%
-
66%
68%
70%
68%
71%
65%
73%
73%
67%
68%
67%
62%
61%
61%
70%
66%
67%
75%
65%
69%
67%
66%
63%
73%
68%
72%
69%
66%
67%
Networks above 99.8% Confidence limit:
N29, N35 & N37
1.1
1.0
0.9
Networks below 99.8% Confidence limit:
N23, N24, N25 & N34
0.8
50
95% Confidence
Interval
% major
resections
Indirectly age-standardised ratio: actual number of NHS treated
colorectal cancer patients with a record of a major resection
divided by the expected number, by cancer network
1.2
70
55
62%
66%
67%
67%
67%
64%
73%
74%
66%
67%
66%
59%
58%
59%
70%
67%
65%
74%
65%
67%
65%
64%
63%
72%
67%
72%
67%
66%
67%
1.3
Networks above 99.8% Confidence limit:
N11, N12, N29, N35 & N37
75
% major
resections
1,135
2,066
1,366
1,802
875
1,341
1,141
616
720
832
730
726
775
978
1,555
768
1,550
861
1,472
1,630
800
1,019
1,103
1,368
2,504
2,214
1,034
2,846
35,827
Percentage of NHS treated colorectal cancer patients with a record of a major resection, by cancer network
80
Percentage of patients
% major
resections
0.7
0
1000
2000
3000
4000
5000
6000
0
7000
Cancer network
England average
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Expected number of patients receiving a major resection
Number of HES linked patients
99.8% confidence limits
cancer network
99.8% confidence limit
The funnel plot of percentages shows that ten cancer networks fall outside the 99.8% confidence limits and therefore have a statistically significant difference from the
average for England in the percentage of patients recorded as having a major resection. The funnel plot of age-standardised ratios between observed and expected
number of patients with a record of a major resection shows that when age-standardised, seven cancer networks fall outside the 99.8% confidence limits. We cannot
exclude the possibility that poor quality data flowing into HES may account for some of the differences seen.
Note: It is important to examine the data for these networks more carefully and investigate further as to what factors may underlie the apparent differences including
coding quality within HES. The percentages shown in the table above do not take into account any factors such as differences in the age-distributions, co-morbidities
or stage at diagnosis of patients between cancer networks.
19
NHS treated patients with a record of a major resection, by sex, age and
deprivation quintile, 2004-2006, followed up to 2007
C33-34: Trachea, bronchus and lung
Of all newly diagnosed cases of lung cancer registered in England in 2004-2006 (excluding Death Certificate Only registrations), 92% were linked to at least one record
within HES. The results presented on these pages show the percentage of these linked, non-DCO patients who had a record of a major resection as part of their
treatment.
Using OPCS-4 codes, operations including pneumonectomy, bilobectomy and lobectomy as well as excisions of the trachea were included as major resections. The full
list of OPCS-4 codes used for lung cancer are included in the appendix.
These results are intending to show any differences in the percentage of NHS treated patients with a record of a major resection by different equality groups; age, sex
and deprivation. However, caution should be taken when interpreting these results due to limitations in using HES data. These results do not show the proportion of
patients who are cured of their cancer through surgery, although it is believed that the large majority of these operations will have been carried out with curative intent.
In addition, the treatment of private patients will not be captured.
Major resections by age and sex
Male
HES linked
patients
Age group
% major
resections
215
1,177
5,655
13,081
17,352
9,881
47,361
Under 40
40-49
50-59
60-69
70-79
80+
All ages
100%
24%
12%
11%
12%
9%
2%
9%
Female
95% Confidence
Interval
19%
10%
11%
11%
9%
2%
9%
-
HES linked
patients
30%
14%
12%
12%
10%
3%
9%
% major
resections
172
1,115
4,401
8,421
11,621
7,431
33,161
21%
17%
14%
13%
9%
2%
9%
Persons
95% Confidence
Interval
16%
14%
13%
12%
8%
2%
9%
-
HES linked
patients
28%
19%
15%
13%
9%
2%
9%
% major
resections
387
2,292
10,056
21,502
28,973
17,312
80,522
23%
14%
13%
12%
9%
2%
9%
95% Confidence
Interval
19%
13%
12%
12%
9%
2%
9%
-
27%
16%
13%
12%
9%
2%
9%
Percentage of NHS treated patients with a record of a major resection for lung cancer, by sex and age group
90%
Percentage
ge of patients
80%
70%
60%
Male
Female
50%
40%
30%
20%
10%
0%
Under 40
40‐49
50‐59
Age group
60‐69
70‐79
80+
Major resections by deprivation quintile and sex
Male
HES linked
patients
Deprivation quintile
6,442
8,336
9,545
10,870
12,168
47,361
Quintile 1 - least deprived
Quintile 2
Quintile 3
Quintile 4
Quintile 5 - most deprived
All quintiles
% major
resections
9%
9%
9%
9%
8%
9%
Female
95% Confidence
Interval
9%
8%
9%
8%
8%
9%
-
HES linked
patients
10%
10%
10%
9%
9%
9%
% major
resections
4,324
5,515
6,648
7,842
8,832
33,161
10%
9%
9%
8%
9%
9%
Persons
95% Confidence
Interval
9%
8%
9%
8%
9%
9%
-
HES linked
patients
11%
10%
10%
9%
10%
9%
% major
resections
10,766
13,851
16,193
18,712
21,000
80,522
10%
9%
9%
9%
9%
9%
95% Confidence
Interval
9%
9%
9%
8%
8%
9%
-
10%
9%
10%
9%
9%
9%
Quintile
100%
Percentage of NHS treated patients with a record of a major resection for lung cancer, by deprivation quintile
90%
Percentage of patients
80%
70%
60%
Male
50%
Female
40%
30%
20%
10%
0%
Least Deprived
Quintile2
Quintile3
Quintile4
Most Deprived
England
Deprivation Quintile
The percentage of patients with a record of a major resection is similar for males and females within each age band. However, there was a higher rate for females in
the 40-49 age band compared to males.
There is a decrease in the percentage of patients with a record of a major resection across age groups. For patients aged 60-69, 12% of patients have a record of a
major resection, compared to 2% of patients aged 80 and over.
For males, there was a difference (-0.24% per quintile) in the percentage of patients with a record of a major resection that was statistically significant (p=0.02). There
was no statistically significant difference in the percentages for females. The percentages by deprivation quintile have not been adjusted for differences in the age
structure
structure.
20
NHS treated patients with a record of a major resection, by sex and cancer
network, 2004-2006 followed up to 2007
C33-34: Trachea, bronchus and lung
The results on this page are a reflection of the surgical treatment data currently available through HES, however, there are limitations in the data available and therefore
these results are being presented in order to stimulate further discussions with the clinical community as to what factors affect surgery rates and how we can improve
data collection. Differences between cancer networks maybe due to higher rates of private patients, later stage of disease at diagnosis, co-morbidities, miscoding or
poor data flow. It is important to read the introduction to this report to understand the limitations of data currently available nationally.
These results are observational; there is no "good" or "bad" percentage from these results. Better quality data are required in order to understand how surgery rates can
affect outcomes. The cancer network relates to the residence of the patient at diagnosis and not the hospital or trust where the patient was treated. Improved data
quality and consistency of coding will allow further research into inequalities in cancer to be undertaken to create a better understanding of how patients are treated
within the NHS and to target efforts to improve their outcomes.
Major resections by cancer network and sex
Male
HES linked
patients
Cancer network
1,676
3,385
2,309
2,705
1,290
2,217
1,725
721
776
1,090
1,019
1,156
1,250
1,040
1,620
709
1,622
836
1,613
1,707
800
1,066
1,479
1,708
4,067
2,570
1,259
3,946
47,361
N01 Lancashire and South Cumbria CN
N02 Greater Manchester and Cheshire CN
N03 Merseyside and Cheshire CN
N06 Yorkshire CN
N07 Humber and Yorkshire Coast CN
N08 North Trent CN
N11 Pan Birmingham CN
N12 Arden CN
N20 Mount Vernon CN
N21 West London CN
N22 North London CN
N23 North East London CN
N24 South East London CN
N25 South West London CN
N26 Peninsula CN
N27 Dorset CN
N28 Avon, Somerset and Wiltshire CN
N29 3 Counties CN
N30 Thames Valley CN
N31 Central South Coast CN
N32 Surrey, West Sussex and Hampshire CN
N33 Sussex CN
N34 Kent and Medway CN
N35 Greater Midlands CN
N36 North of England CN
N37 Anglia CN
N38 Essex CN
N39 East Midlands CN
England
5%
9%
13%
10%
10%
7%
12%
11%
6%
10%
7%
8%
8%
7%
9%
10%
8%
8%
7%
8%
7%
6%
6%
10%
9%
10%
6%
11%
9%
Female
95% Confidence
Interval
4%
8%
12%
9%
9%
6%
11%
9%
5%
8%
6%
7%
6%
6%
7%
8%
7%
6%
6%
7%
5%
5%
5%
9%
8%
9%
5%
10%
9%
-
HES linked
patients
6%
10%
15%
11%
12%
8%
14%
13%
8%
11%
9%
10%
9%
9%
10%
12%
9%
10%
8%
9%
9%
7%
8%
12%
10%
11%
7%
12%
9%
18
Age-Standardised Ratio
12
10
8
6
-
7%
10%
14%
12%
11%
9%
13%
17%
8%
14%
12%
11%
9%
13%
11%
14%
11%
10%
9%
8%
11%
8%
9%
15%
10%
11%
7%
12%
9%
2,928
5,894
4,205
4,808
2,175
3,807
2,780
1,176
1,352
1,887
1,748
1,946
2,147
1,837
2,662
1,234
2,720
1,362
2,698
2,868
1,379
1,789
2,435
2,722
7,170
4,187
2,134
6,472
80,522
% major
resections
95% Confidence
Interval
5%
9%
13%
10%
10%
7%
12%
12%
6%
11%
8%
9%
8%
9%
9%
10%
8%
8%
7%
7%
8%
6%
7%
11%
9%
10%
6%
11%
9%
5%
8%
12%
9%
9%
7%
11%
10%
5%
9%
7%
8%
7%
8%
8%
9%
7%
6%
6%
7%
6%
5%
6%
10%
8%
9%
5%
10%
9%
-
6%
10%
14%
11%
11%
8%
13%
14%
7%
12%
9%
10%
9%
10%
10%
12%
10%
9%
8%
8%
9%
7%
8%
13%
9%
11%
7%
12%
9%
Indirectly age-standardised ratio: actual number of NHS treated
lung cancer patients with a record of a major resection divided by
the expected number, by cancer network
Networks above 99.8% Confidence limit:
N03, N11, N35 & N39
1.6
1.4
1.2
1.0
0.8
0.6
0.4
Networks below 99.8% Confidence limit:
N01, N08, N20, N30, N33, N34 & N38
2
4%
8%
11%
9%
8%
7%
10%
11%
4%
10%
7%
7%
6%
9%
8%
8%
8%
6%
6%
5%
6%
4%
6%
11%
8%
8%
4%
9%
9%
HES linked
patients
1.8
14
4
Persons
95% Confidence
Interval
6%
9%
13%
11%
9%
8%
11%
14%
5%
12%
9%
9%
8%
11%
9%
11%
9%
8%
8%
7%
8%
6%
7%
13%
8%
10%
6%
11%
9%
2.0
Networks above 99.8% Confidence limit:
N03, N11, N12, N35 & N39
16
% major
resections
1,252
2,509
1,896
2,103
885
1,590
1,055
455
576
797
729
790
897
797
1,042
525
1,098
526
1,085
1,161
579
723
956
1,014
3,103
1,617
875
2,526
33,161
Percentage of NHS treated lung cancer patients with a record of a major resection, by cancer network
20
Percentage of patients
% major
resections
Networks below 99.8% Confidence limit:
N01, N08, N20, N33, N34 & N38
0.2
0.0
0
0
1000
2000
3000
4000
5000
6000
0
7000
England average
200
300
400
500
600
700
Expected number of patients receiving a major resection
Number of HES linked patients
Cancer network
100
cancer network
99.8% confidence limits
99.8% confidence limit
The funnel plots show that twelve cancer networks fall outside the 99.8% confidence limits and therefore the difference from the average for England in the percentage
of patients recorded as having a major resection is statistically significant for these networks. The funnel plot of age-standardised ratios between observed and
expected number of patients with a record of a major resection shows that ten cancer networks fall outside the 99.8% confidence limits. We cannot exclude the
possibility that poor quality data flowing into HES may account for some of the differences seen.
Note: It is important to examine the data for these networks more carefully and investigate further as to what factors may underlie the apparent differences including
coding quality within HES. The percentages shown in the table above do not take into account any factors such as differences in the age-distributions, co-morbidities
or stage at diagnosis of patients between cancer networks.
21
NHS treated patients with a record of a major resection, by sex, age and
deprivation quintile, 2004-2006, followed up to 2007
C50: Breast
Of all newly diagnosed cases of breast cancer registered in England in 2004-2006 (excluding Death Certificate Only registrations), 88% were linked to at least one
record within HES. The results presented on these pages show the percentage of these linked, non-DCO patients who had a record of a major resection as part of their
treatment.
Using OPCS-4 codes, operations that have been defined as major resections include total excision of breast, partial excision and excision of lesion of breast and duct
of breast. The full list of OPCS-4 codes used for breast cancer is included in the appendix.
These results are intending to show any differences in the percentage of NHS treated patients with a record of a major resection by different equality groups; age, sex
and deprivation. However, caution should be taken when interpreting these results due to limitations in using HES data. These results do not show the proportion of
patients who are cured of their cancer through surgery, although it is believed that the large majority of these operations will have been carried out with curative intent.
In addition, the treatment of private patients will not be captured.
Major resections by age and sex
Male
HES linked
patients
Age group
% major
resections
18
47
100
173
214
144
696
Under 40
40-49
50-59
60-69
70-79
80+
All ages
100%
83%
85%
85%
87%
76%
64%
78%
Female
95% Confidence
Interval
61%
72%
77%
81%
70%
56%
75%
-
HES linked
patients
94%
93%
91%
91%
81%
71%
81%
% major
resections
4,870
14,651
23,849
24,598
17,093
11,933
96,994
87%
89%
90%
90%
81%
51%
83%
Persons
95% Confidence
Interval
86%
88%
90%
90%
80%
50%
83%
-
HES linked
patients
88%
89%
91%
91%
81%
52%
84%
4,888
14,698
23,949
24,771
17,307
12,077
97,690
% major
resections
87%
89%
90%
90%
81%
51%
83%
95% Confidence
Interval
86%
88%
90%
90%
80%
50%
83%
-
88%
89%
91%
90%
81%
52%
83%
Percentage of NHS treated patients with a record of a major resection for breast cancer, by sex and age group
90%
Percentage
ge of patients
80%
70%
60%
Male
Female
50%
40%
30%
20%
10%
0%
Under 40
40‐49
50‐59
Age group
60‐69
70‐79
80+
Major resections by deprivation quintile and sex
Male
HES linked
patients
Deprivation quintile
% major
resections
Female
95% Confidence
Interval
HES linked
patients
% major
resections
20,413
21,464
20,988
18,983
15,146
96,994
Quintile 1 - least deprived
Quintile 2
Quintile 3
Quintile 4
Quintile 5 - most deprived
All quintiles
84%
84%
84%
82%
82%
83%
Persons
95% Confidence
Interval
84%
83%
83%
82%
81%
83%
-
HES linked
patients
% major
resections
95% Confidence
Interval
85%
84%
84%
83%
82%
84%
Quintile
100%
Percentage of NHS treated patients with a record of a major resection for breast cancer, by deprivation quintile
90%
Percentage of patients
80%
70%
60%
50%
Female
40%
30%
20%
10%
0%
Least Deprived
Quintile2
Quintile3
Quintile4
Most Deprived
England
Deprivation Quintile
Overall 83% of NHS treated breast cancer patients have a record of a major resection. There is a decrease with age in the percentage of female breast cancer patients
with a record of a major resection aged 70 and over. In patients aged 60-69, 90% of females had a record of a major resection compared to 81% of 70-79 year olds
and 51% of female patients aged 80 and over.
Across the deprivation quintiles, there was a slight decrease (-0.7%) in the percentage of patients with a record of a major resection for females by deprivation quintile
that was statistically significant (p=0.022). The percentages by deprivation quintile have not been adjusted for differences in the age structure.
22
NHS treated patients with a record of a major resection, by sex and cancer
network, 2004-2006 followed up to 2007
C50: Breast
The results on this page are a reflection of the surgical treatment data currently available through HES, however, there are limitations in the data available and therefore
these results are being presented in order to stimulate further discussions with the clinical community as to what factors affect surgery rates and how we can improve
data collection. Differences between cancer networks maybe due to higher rates of private patients, later stage of disease at diagnosis, co-morbidities, miscoding or
poor data flow. It is important to read the introduction to this report to understand the limitations of data currently available nationally.
These results are observational; there is no "good" or "bad" percentage from these results. Better quality data are required in order to understand how surgery rates can
affect outcomes. The cancer network relates to the residence of the patient at diagnosis and not the hospital or trust where the patient was treated. Improved data
quality and consistency of coding will allow further research into inequalities in cancer to be undertaken to create a better understanding of how patients are treated
within the NHS and to target efforts to improve their outcomes.
Major resections by cancer network and sex
Male
HES linked
patients
Cancer network
% major
resections
Female
95% Confidence
Interval
HES linked
patients
3,294
5,857
4,151
4,729
2,149
3,796
3,397
1,863
1,917
2,464
1,981
1,950
2,261
2,332
4,082
1,782
4,112
2,348
4,252
4,229
2,056
2,344
3,022
4,041
6,361
5,489
2,691
8,044
96,994
N01 Lancashire and South Cumbria CN
N02 Greater Manchester and Cheshire CN
N03 Merseyside and Cheshire CN
N06 Yorkshire CN
N07 Humber and Yorkshire Coast CN
N08 North Trent CN
N11 Pan Birmingham CN
N12 Arden CN
N20 Mount Vernon CN
N21 West London CN
N22 North London CN
N23 North East London CN
N24 South East London CN
N25 South West London CN
N26 Peninsula CN
N27 Dorset CN
N28 Avon, Somerset and Wiltshire CN
N29 3 Counties CN
N30 Thames Valley CN
N31 Central South Coast CN
N32 Surrey, West Sussex and Hampshire CN
N33 Sussex CN
N34 Kent and Medway CN
N35 Greater Midlands CN
N36 North of England CN
N37 Anglia CN
N38 Essex CN
N39 East Midlands CN
England
Percentage of NHS treated breast cancer patients with a record of a major resection, by cancer network
Percentage of patients
Networks above 99.8% Confidence limit:
N06, N11, N12, N26, N35 & N37
85
82%
83%
85%
87%
85%
82%
88%
87%
81%
81%
81%
80%
81%
80%
85%
79%
82%
83%
85%
84%
83%
82%
79%
86%
83%
85%
82%
83%
83%
Persons
95% Confidence
Interval
80%
82%
84%
86%
83%
81%
86%
86%
79%
80%
79%
78%
79%
78%
84%
77%
81%
82%
83%
83%
82%
80%
78%
85%
82%
84%
81%
82%
83%
-
HES linked
patients
% major
resections
95% Confidence
Interval
83%
84%
86%
88%
86%
83%
89%
89%
83%
83%
83%
81%
83%
81%
86%
81%
83%
85%
86%
85%
85%
83%
81%
87%
84%
86%
83%
84%
84%
Indirectly age-standardised ratio: actual number of NHS treated
breast cancer patients with a record of a major resection divided
by the expected number, by cancer network
1.2
Age-Standardised Ratio
95
% major
resections
Networks above 99.8% Confidence limit:
None
1.1
1.0
0.9
Networks below 99.8% Confidence limit:
N23, N25, N27 & N34
Networks below 99.8% Confidence limit:
None
75
0.8
0
2000
4000
6000
8000
0
10000
Cancer network
England average
1000
2000
3000
4000
5000
6000
7000
Expected number of patients receiving a major resection
Number of HES linked patients
99.8% confidence limits
cancer network
99.8% confidence limit
The funnel plot of percentages shows that ten cancer networks fall outside the 99.8% confidence limits and therefore the difference from the average for England in the
percentage of patients recorded as having a major resection is statistically significant for these cancer networks. However, the funnel plot for age-standardised ratios
shows that all networks fall within the 99.8% confidence limits and therefore differences between networks are not statistically significant when age is taken into
account.
Note: The percentages shown in the table above do not take into account any factors such as differences in the age-distributions, co-morbidities or stage at diagnosis
of patients between cancer networks.
23
NHS treated patients with a record of a major resection, by sex, age and
deprivation quintile, 2004-2006, followed up to 2007
C53: Cervix
Of all newly diagnosed cases of cervical cancer registered in England in 2004-2006 (excluding Death Certificate Only registrations), 89% were linked to at least one
record within HES. The results presented on these pages show the percentage of these linked, non-DCO patients who had a record of a major resection as part of their
treatment.
Using OPCS-4 codes, operations that have been defined as major resections include hysterectomy and hysterocolpectomy. The full list of OPCS-4 codes used for
cervical cancer is included in the appendix.
These results are intending to show any differences in the percentage of NHS treated patients with a record of a major resection by different equality groups; age, sex
and deprivation. However, caution should be taken when interpreting these results due to limitations in using HES data. These results do not show the proportion of
patients who are cured of their cancer through surgery, although it is believed that the large majority of these operations will have been carried out with curative intent.
In addition, the treatment of private patients will not be captured.
Major resections by age and sex
Male
HES linked
patients
Age group
% major
resections
Female
95% Confidence
Interval
HES linked
patients
% major
resections
2,045
1,217
932
676
584
553
6,007
Under 40
40-49
50-59
60-69
70-79
80+
All ages
100%
60%
58%
42%
31%
14%
10%
45%
Persons
95% Confidence
Interval
58%
55%
39%
28%
12%
8%
43%
-
HES linked
patients
% major
resections
95% Confidence
Interval
62%
61%
45%
35%
17%
13%
46%
Percentage of NHS treated patients with a record of a major resection for cancer of the cervix, by sex and age group
90%
Percentage
ge of patients
80%
70%
60%
Female
50%
40%
30%
20%
10%
0%
Under 40
40‐49
50‐59
Age group
60‐69
70‐79
80+
Major resections by deprivation quintile and sex
Male
HES linked
patients
Deprivation quintile
% major
resections
Female
95% Confidence
Interval
HES linked
patients
% major
resections
901
1,006
1,175
1,357
1,568
6,007
Quintile 1 - least deprived
Quintile 2
Quintile 3
Quintile 4
Quintile 5 - most deprived
All quintiles
50%
46%
47%
43%
40%
45%
Persons
95% Confidence
Interval
47%
43%
44%
41%
37%
43%
-
HES linked
patients
% major
resections
95% Confidence
Interval
53%
49%
50%
46%
42%
46%
Quintile
100%
Percentage of NHS treated patients with a record of a major resection for cancer of the cervix, by deprivation quintile
90%
Percentage of patients
80%
70%
60%
50%
Female
40%
30%
20%
10%
0%
Least Deprived
Quintile2
Quintile3
Quintile4
Most Deprived
England
Deprivation Quintile
Overall, 45% of NHS treated cervical cancer patients have a record of a major resection.
There is a decrease with age in the percentage of patients with a record of a major resection. For patients aged under 40, around 60% have a record of a major
resection. In patients aged 60-69, 31% have a record of a major resection and for patients aged 80 and over, 10% have a record of a major resection.
Across the deprivation quintiles, there was a decrease (-2.3% per quintile) in the percentage of patients with a record of a major resection for females by deprivation
quintile that was statistically significant (p=0.01). The percentages by deprivation quintile have not been adjusted for differences in the age structure.
24
NHS treated patients with a record of a major resection, by sex and cancer
network, 2004-2006 followed up to 2007
C53: Cervix
The results on this page are a reflection of the surgical treatment data currently available through HES, however, there are limitations in the data available and therefore
these results are being presented in order to stimulate further discussions with the clinical community as to what factors affect surgery rates and how we can improve
data collection. Differences between cancer networks maybe due to higher rates of private patients, later stage of disease at diagnosis, co-morbidities, miscoding or
poor data flow. It is important to read the introduction to this report to understand the limitations of data currently available nationally.
These results are observational; there is no "good" or "bad" percentage from these results. Better quality data are required in order to understand how surgery rates can
affect outcomes. The cancer network relates to the residence of the patient at diagnosis and not the hospital or trust where the patient was treated. Improved data
quality and consistency of coding will allow further research into inequalities in cancer to be undertaken to create a better understanding of how patients are treated
within the NHS and to target efforts to improve their outcomes.
Major resections by cancer network and sex
Male
HES linked
patients
Cancer network
% major
resections
Female
95% Confidence
Interval
HES linked
patients
181
424
273
374
210
235
264
116
96
173
123
142
174
148
238
86
249
80
247
229
101
103
153
266
396
234
124
568
6,007
N01 Lancashire and South Cumbria CN
N02 Greater Manchester and Cheshire CN
N03 Merseyside and Cheshire CN
N06 Yorkshire CN
N07 Humber and Yorkshire Coast CN
N08 North Trent CN
N11 Pan Birmingham CN
N12 Arden CN
N20 Mount Vernon CN
N21 West London CN
N22 North London CN
N23 North East London CN
N24 South East London CN
N25 South West London CN
N26 Peninsula CN
N27 Dorset CN
N28 Avon, Somerset and Wiltshire CN
N29 3 Counties CN
N30 Thames Valley CN
N31 Central South Coast CN
N32 Surrey, West Sussex and Hampshire CN
N33 Sussex CN
N34 Kent and Medway CN
N35 Greater Midlands CN
N36 North of England CN
N37 Anglia CN
N38 Essex CN
N39 East Midlands CN
England
42%
34%
35%
40%
46%
35%
36%
39%
32%
29%
18%
23%
39%
35%
40%
36%
46%
32%
45%
49%
42%
37%
36%
44%
42%
34%
25%
43%
43%
-
HES linked
patients
Age-Standardised Ratio
40
95% Confidence
Interval
56%
44%
47%
50%
59%
47%
48%
57%
52%
43%
33%
38%
54%
51%
52%
57%
58%
53%
58%
62%
61%
56%
51%
56%
52%
47%
41%
51%
46%
1.8
50
% major
resections
Indirectly age-standardised ratio: actual number of NHS treated
cervical cancer patients with a record of a major resection divided
by the expected number, by cancer network
2.0
Networks above 99.8% Confidence limit:
N31
60
Percentage of patients
49%
39%
41%
45%
52%
41%
42%
48%
42%
36%
24%
30%
47%
43%
46%
47%
52%
43%
51%
56%
51%
47%
43%
50%
47%
40%
32%
47%
45%
Percentage of NHS treated cervical cancer patients with a record of a major resection, by cancer network
70
Persons
95% Confidence
Interval
% major
resections
Networks above 99.8% Confidence limit:
None
1.6
1.4
1.2
1.0
0.8
0.6
30
0.4
Networks below 99.8% Confidence limit:
N22 & N23
Networks below 99.8% Confidence limit:
N22
0.2
20
0.0
0
100
200
300
400
500
600
0
Cancer network
England average
50
100
150
200
250
Expected number of patients receiving a major resection
Number of HES linked patients
99.8% confidence limits
cancer network
99.8% confidence limit
The funnel plots show that the majority of cancer networks fall within the 99.8% confidence limits and therefore the difference from the average for England in the
percentage of patients recorded as having a major resection is not statistically significant for these cancer networks. However, three cancer networks do fall outside the
confidence limits. The funnel plot for age-standardised ratios shows that only one network falls below the 99.8% confidence limit when age is taken into account. We
cannot exclude the possibility that poor quality data flowing into HES may account for some of the differences seen.
Note: It is important to examine the data for these networks more carefully and investigate further as to what factors may underlie the apparent differences including
coding quality within HES. The percentages shown in the table above do not take into account any factors such as differences in the age-distributions, co-morbidities
or stage at diagnosis of patients between cancer networks.
25
NHS treated patients with a record of a major resection, by sex, age and
deprivation quintile, 2004-2006, followed up to 2007
C54-55: Uterus
Of all newly diagnosed cases of uterine cancer registered in England in 2004-2006 (excluding Death Certificate Only registrations), 91% were linked to at least one
record within HES. The results presented on these pages show the percentage of these linked, non-DCO patients who had a record of a major resection as part of their
treatment.
Using OPCS-4 codes, operations that have been defined as major resections include hysterectomy and hysterocolpectomy. The full list of OPCS-4 codes used for
uterine cancer is included in the appendix.
These results are intending to show any differences in the percentage of NHS treated patients with a record of a major resection by different equality groups; age, sex
and deprivation. However, caution should be taken when interpreting these results due to limitations in using HES data. These results do not show the proportion of
patients who are cured of their cancer through surgery, although it is believed that the large majority of these operations will have been carried out with curative intent.
In addition, the treatment of private patients will not be captured.
Major resections by age and sex
Male
HES linked
patients
Age group
% major
resections
Female
95% Confidence
Interval
HES linked
patients
% major
resections
204
837
3,556
4,731
3,900
2,146
15,374
Under 40
40-49
50-59
60-69
70-79
80+
All ages
100%
80%
87%
89%
89%
83%
65%
84%
Persons
95% Confidence
Interval
74%
85%
88%
88%
82%
63%
84%
-
HES linked
patients
% major
resections
95% Confidence
Interval
85%
89%
90%
90%
85%
67%
85%
Percentage of NHS treated patients with a record of a major resection for cancer of the uterus, by sex and age group
90%
Percentage
ge of patients
80%
70%
60%
Female
50%
40%
30%
20%
10%
0%
Under 40
40‐49
50‐59
Age group
60‐69
70‐79
80+
Major resections by deprivation quintile and sex
Male
HES linked
patients
Deprivation quintile
% major
resections
Female
95% Confidence
Interval
HES linked
patients
% major
resections
2,943
3,427
3,402
3,033
2,569
15,374
Quintile 1 - least deprived
Quintile 2
Quintile 3
Quintile 4
Quintile 5 - most deprived
All quintiles
83%
86%
84%
84%
83%
84%
Persons
95% Confidence
Interval
82%
84%
83%
83%
82%
84%
-
HES linked
patients
% major
resections
95% Confidence
Interval
84%
87%
85%
86%
85%
85%
Quintile
100%
Percentage of NHS treated patients with a record of a major resection for cancer of the uterus, by deprivation quintile
90%
Percentage of patients
80%
70%
60%
50%
Female
40%
30%
20%
10%
0%
Least Deprived
Quintile2
Quintile3
Quintile4
Most Deprived
England
Deprivation Quintile
Overall, 84% of NHS treated uterine cancer patients have a record of a major resection. There is a decrease with age in the percentage of older uterine cancer patients
with a record of a major resection. For patients aged 60-69, 89% have a record of a major resection. In patients aged 70-79, 83% had a record of a major resection
and for patients aged 80 and over, 65% had a record of a major resection.
Across deprivation quintiles, there was no statistically significant change in the percentage of patients with a record of a major resection for females. The percentages
by deprivation quintile have not been adjusted for differences in the age structure.
26
NHS treated patients with a record of a major resection, by sex and cancer
network, 2004-2006 followed up to 2007
C54-55: Uterus
The results on this page are a reflection of the surgical treatment data currently available through HES, however, there are limitations in the data available and therefore
these results are being presented in order to stimulate further discussions with the clinical community as to what factors affect surgery rates and how we can improve
data collection. Differences between cancer networks maybe due to higher rates of private patients, later stage of disease at diagnosis, co-morbidities, miscoding or
poor data flow. It is important to read the introduction to this report to understand the limitations of data currently available nationally.
These results are observational; there is no "good" or "bad" percentage from these results. Better quality data are required in order to understand how surgery rates can
affect outcomes. The cancer network relates to the residence of the patient at diagnosis and not the hospital or trust where the patient was treated. Improved data
quality and consistency of coding will allow further research into inequalities in cancer to be undertaken to create a better understanding of how patients are treated
within the NHS and to target efforts to improve their outcomes.
Major resections by cancer network and sex
Male
HES linked
patients
Cancer network
% major
resections
Female
95% Confidence
Interval
HES linked
patients
513
868
560
694
397
617
606
315
268
367
374
368
372
368
679
294
658
373
607
609
290
378
502
645
893
993
457
1,309
15,374
N01 Lancashire and South Cumbria CN
N02 Greater Manchester and Cheshire CN
N03 Merseyside and Cheshire CN
N06 Yorkshire CN
N07 Humber and Yorkshire Coast CN
N08 North Trent CN
N11 Pan Birmingham CN
N12 Arden CN
N20 Mount Vernon CN
N21 West London CN
N22 North London CN
N23 North East London CN
N24 South East London CN
N25 South West London CN
N26 Peninsula CN
N27 Dorset CN
N28 Avon, Somerset and Wiltshire CN
N29 3 Counties CN
N30 Thames Valley CN
N31 Central South Coast CN
N32 Surrey, West Sussex and Hampshire CN
N33 Sussex CN
N34 Kent and Medway CN
N35 Greater Midlands CN
N36 North of England CN
N37 Anglia CN
N38 Essex CN
N39 East Midlands CN
England
Percentage of NHS treated uterine cancer patients with a record of a major resection, by cancer network
100
Persons
95% Confidence
Interval
82%
79%
81%
81%
90%
84%
87%
85%
81%
83%
80%
81%
86%
82%
85%
77%
85%
82%
83%
83%
84%
87%
78%
91%
91%
88%
86%
84%
84%
79%
76%
77%
77%
87%
81%
84%
80%
75%
79%
75%
77%
82%
78%
83%
72%
82%
78%
79%
80%
79%
83%
75%
88%
89%
86%
83%
82%
84%
-
HES linked
patients
Age-Standardised Ratio
80
Networks below 99.8% Confidence limit:
N02
Networks above 99.8% Confidence limit:
None
1.2
1.0
0.8
Networks below 99.8% Confidence limit:
None
0.6
70
95% Confidence
Interval
86%
81%
84%
83%
93%
87%
90%
88%
85%
87%
83%
85%
89%
85%
88%
82%
88%
85%
86%
86%
88%
90%
82%
93%
92%
90%
89%
86%
85%
1.4
90
% major
resections
Indirectly age-standardised ratio: actual number of NHS treated
uterine cancer patients with a record of a major resection divided
by the expected number, by cancer network
1.6
Networks above 99.8% Confidence limit:
N07, N35, N36 & N37
Percentage of patients
% major
resections
0.4
0
200
400
600
800
1000
1200
1400
0
Number of HES linked patients
Cancer network
England average
200
400
600
800
1000
1200
Expected number of patients receiving a major resection
99.8% confidence limits
cancer network
99.8% confidence limit
The funnel plot of percentages shows that five cancer networks fall outside the 99.8% confidence limits and therefore have a statistically significant difference from the
average for England in the percentage of patients recorded as having a major resection. However, the funnel plot of age-standardised ratios shows that all networks
fall within the 99.8% confidence limits.
Note: The percentages shown in the table above do not take into account any factors such as differences in the age-distributions, co-morbidities or stage at diagnosis
of patients between cancer networks.
27
NHS treated patients with a record of a major resection, by sex, age and
deprivation quintile, 2004-2006, followed up to 2007
C56: Ovary
Of all newly diagnosed cases of ovarian cancer registered in England in 2004-2006 (excluding Death Certificate Only registrations), 91% were linked to at least one
record within HES. The results presented on these pages show the percentage of these linked, non-DCO patients who had a record of a major resection as part of their
treatment.
Using OPCS-4 codes, operations that have been defined as major resections include oophorectomys and salpingoophorectomy, and other excisions of ovary and
uterus. The full list of OPCS-4 codes used for ovarian cancer is included in the appendix.
These results are intending to show any differences in the percentage of NHS treated patients with a record of a major resection by different equality groups; age, sex
and deprivation. However, caution should be taken when interpreting these results due to limitations in using HES data. These results do not show the proportion of
patients who are cured of their cancer through surgery, although it is believed that the large majority of these operations will have been carried out with curative intent.
In addition, the treatment of private patients will not be captured.
Major resections by age and sex
Male
HES linked
patients
Age group
% major
resections
Female
95% Confidence
Interval
HES linked
patients
% major
resections
888
1,324
2,801
3,687
3,502
2,242
14,444
Under 40
40-49
50-59
60-69
70-79
80+
All ages
100%
83%
82%
74%
63%
48%
26%
59%
Persons
95% Confidence
Interval
80%
80%
72%
62%
46%
24%
58%
-
HES linked
patients
% major
resections
95% Confidence
Interval
85%
84%
75%
65%
49%
28%
59%
Percentage of NHS treated patients with a record of a major resection for ovarian cancer, by sex and age group
90%
Percentage
ge of patients
80%
70%
60%
Female
50%
40%
30%
20%
10%
0%
Under 40
40‐49
50‐59
Age group
60‐69
70‐79
80+
Major resections by deprivation quintile and sex
Male
HES linked
patients
Deprivation quintile
% major
resections
Female
95% Confidence
Interval
HES linked
patients
% major
resections
2,883
3,132
3,210
2,887
2,332
14,444
Quintile 1 - least deprived
Quintile 2
Quintile 3
Quintile 4
Quintile 5 - most deprived
All quintiles
60%
59%
58%
58%
59%
59%
Persons
95% Confidence
Interval
58%
57%
56%
56%
57%
58%
-
HES linked
patients
% major
resections
95% Confidence
Interval
62%
61%
59%
60%
61%
59%
Quintile
100%
Percentage of NHS treated patients with a record of a major resection for ovarian cancer, by deprivation quintile
90%
Percentage of patients
80%
70%
60%
50%
Female
40%
30%
20%
10%
0%
Least Deprived
Quintile2
Quintile3
Quintile4
Most Deprived
England
Deprivation Quintile
Overall, 59% of NHS treated ovarian cancer patients have a record of a major resection. However, there is a decrease with age in the percentage of ovarian cancer
patients with a record of a major resection. For patients aged under 40 and 40-49, around 83% have a record of a major resection. In patients aged 60-69, 63% have a
record of a major resection and for patients aged 80 and over, 26% have a record of a major resection.
Across the deprivation quintiles, there was no statistically significant change in the percentage of patients with a record of a major resection for females. The
percentages by deprivation quintile have not been adjusted for differences in the age structure.
28
NHS treated patients with a record of a major resection, by sex and cancer
network, 2004-2006 followed up to 2007
C56: Ovary
The results on this page are a reflection of the surgical treatment data currently available through HES, however, there are limitations in the data available and therefore
these results are being presented in order to stimulate further discussions with the clinical community as to what factors affect surgery rates and how we can improve
data collection. Differences between cancer networks maybe due to higher rates of private patients, later stage of disease at diagnosis, co-morbidities, miscoding or
poor data flow. It is important to read the introduction to this report to understand the limitations of data currently available nationally.
These results are observational; there is no "good" or "bad" percentage from these results. Better quality data are required in order to understand how surgery rates can
affect outcomes. The cancer network relates to the residence of the patient at diagnosis and not the hospital or trust where the patient was treated. Improved data
quality and consistency of coding will allow further research into inequalities in cancer to be undertaken to create a better understanding of how patients are treated
within the NHS and to target efforts to improve their outcomes.
Major resections by cancer network and sex
Male
HES linked
patients
Cancer network
% major
resections
Female
95% Confidence
Interval
HES linked
patients
521
896
596
606
292
570
497
275
257
310
280
266
301
366
748
300
697
332
632
645
275
324
407
619
960
809
440
1,223
14,444
N01 Lancashire and South Cumbria CN
N02 Greater Manchester and Cheshire CN
N03 Merseyside and Cheshire CN
N06 Yorkshire CN
N07 Humber and Yorkshire Coast CN
N08 North Trent CN
N11 Pan Birmingham CN
N12 Arden CN
N20 Mount Vernon CN
N21 West London CN
N22 North London CN
N23 North East London CN
N24 South East London CN
N25 South West London CN
N26 Peninsula CN
N27 Dorset CN
N28 Avon, Somerset and Wiltshire CN
N29 3 Counties CN
N30 Thames Valley CN
N31 Central South Coast CN
N32 Surrey, West Sussex and Hampshire CN
N33 Sussex CN
N34 Kent and Medway CN
N35 Greater Midlands CN
N36 North of England CN
N37 Anglia CN
N38 Essex CN
N39 East Midlands CN
England
Percentage of NHS treated ovarian cancer patients with a record of a major resection, by cancer network
Persons
95% Confidence
Interval
46%
51%
49%
55%
48%
59%
61%
53%
55%
45%
52%
49%
47%
57%
48%
54%
60%
56%
54%
50%
55%
40%
51%
58%
68%
58%
56%
58%
58%
-
HES linked
patients
60
95% Confidence
Interval
% major
resections
55%
57%
57%
63%
60%
67%
69%
65%
66%
56%
64%
61%
58%
67%
55%
65%
67%
66%
62%
58%
66%
51%
61%
66%
74%
64%
65%
63%
59%
Indirectly age-standardised ratio: actual number of NHS treated
ovarian cancer patients with a record of a major resection divided
by the expected number, by cancer network
1.8
Networks above 99.8% Confidence limit:
N36
70
51%
54%
53%
59%
54%
64%
65%
59%
61%
50%
58%
55%
52%
62%
52%
60%
63%
61%
58%
54%
61%
46%
56%
62%
71%
61%
61%
60%
59%
2.0
Age-Standardised Ratio
Percentage of patients
80
% major
resections
Networks above 99.8% Confidence limit:
N36
1.6
1.4
1.2
1.0
0.8
0.6
50
0.4
Networks below 99.8% Confidence limit:
N01, N26 & N33
Networks below 99.8% Confidence limit:
N33
0.2
0.0
40
0
200
400
600
800
1000
0
1200
Cancer network
England average
100
200
300
400
500
600
700
Expected number of patients receiving a major resection
Number of HES linked patients
99.8% confidence limits
cancer network
99.8% confidence limit
The funnel plot of percentages show that four cancer networks fall outside the 99.8% confidence limits and therefore the difference is statistically significant from the
average for England in the percentage of patients recorded as having a major resection for these networks. The funnel plot of age-standardised ratios shows that only
two networks falls outside the 99.8% confidence limits. We cannot exclude the possibility that poor quality data flowing into HES may account for some of the
differences seen.
Note: It is important to examine the data for these networks more carefully and investigate further as to what factors may underlie the apparent differences including
coding quality within HES. The percentages shown in the table above do not take into account any factors such as differences in the age-distributions, co-morbidities
or stage at diagnosis of patients between cancer networks.
29
NHS treated patients with a record of a major resection, by sex, age and
deprivation quintile, 2004-2006, followed up to 2007
C61: Prostate
Of all newly diagnosed cases of prostate cancer registered in England in 2004-2006 (excluding Death Certificate Only registrations), 73% were linked to at least one
record within HES. The results presented on these pages show the percentage of these linked, non-DCO patients who had a record of a major resection as part of their
treatment.
Using OPCS-4 codes, operations such as total/radical prostatectomy and perineal prostatectomy were included as major resections. The full list of OPCS-4 codes used
for prostate cancer are included in the appendix.
These results are intending to show any differences in the percentage of NHS treated patients with a record of a major resection by different equality groups; age, sex
and deprivation. However, caution should be taken when interpreting these results due to limitations in using HES data. These results do not show the proportion of
patients who are cured of their cancer through surgery, although it is believed that the large majority of these operations will have been carried out with curative intent.
In addition, the treatment of private patients will not be captured.
For prostate cancer, a larger proportion of patients are not treated as inpatients or day cases (see appendix 2). Please note that only patients who have a record of
being treated in an inpatient or day case setting are included in these analyses.
Major resections by age and sex
Male
HES linked
patients
Age group
% major
resections
26
516
6,743
19,835
23,172
13,648
63,940
Under 40
40-49
50-59
60-69
70-79
80+
All ages
100%
19%
35%
30%
19%
2%
0%
10%
Female
95% Confidence
Interval
9%
31%
29%
18%
2%
0%
10%
-
HES linked
patients
% major
resections
Persons
95% Confidence
Interval
HES linked
patients
% major
resections
95% Confidence
Interval
38%
39%
31%
19%
2%
0%
10%
Percentage of NHS treated patients with a record of a major resection for prostate cancer, by sex and age group
90%
Percentage
ge of patients
80%
70%
60%
Male
50%
40%
30%
20%
10%
0%
Under 40
40‐49
50‐59
Age group
60‐69
70‐79
80+
Major resections by deprivation quintile and sex
Male
HES linked
patients
Deprivation quintile
14,111
14,869
13,734
11,671
9,555
63,940
Quintile 1 - least deprived
Quintile 2
Quintile 3
Quintile 4
Quintile 5 - most deprived
All quintiles
% major
resections
13%
11%
9%
9%
7%
10%
Female
95% Confidence
Interval
12%
10%
9%
8%
7%
10%
-
HES linked
patients
% major
resections
Persons
95% Confidence
Interval
HES linked
patients
% major
resections
95% Confidence
Interval
13%
12%
10%
9%
8%
10%
Quintile
100%
Percentage of NHS treated patients with a record of a major resection for prostate cancer, by deprivation quintile
90%
Percentage of patients
80%
70%
60%
Male
50%
40%
30%
20%
10%
0%
Least Deprived
Quintile2
Quintile3
Quintile4
Most Deprived
England
Deprivation Quintile
Overall, 10% of NHS treated prostate cancer patients had a record of a major resection for their cancer.
There is variation with age with 35% of patients aged 40-49 receiving a major resection, 19% of patients aged 60-69 and less than 0.1% of patients aged 80 and over.
There was a decrease in the percentage of patients with a record of a major resection for males by deprivation quintile that was statistically significant (-1.2%, p=0.001).
The percentages by deprivation quintile have not been adjusted for differences in the age structure.
30
NHS treated patients with a record of a major resection, by sex and cancer
network, 2004-2006 followed up to 2007
C61: Prostate
The results on this page are a reflection of the surgical treatment data currently available through HES, however, there are limitations in the data available and therefore
these results are being presented in order to stimulate further discussions with the clinical community as to what factors affect surgery rates and how we can improve
data collection. Differences between cancer networks maybe due to higher rates of private patients, later stage of disease at diagnosis, co-morbidities, miscoding or
poor data flow. It is important to read the introduction to this report to understand the limitations of data currently available nationally.
These results are observational; there is no "good" or "bad" percentage from these results. Better quality data are required in order to understand how surgery rates can
affect outcomes. The cancer network relates to the residence of the patient at diagnosis and not the hospital or trust where the patient was treated. Improved data
quality and consistency of coding will allow further research into inequalities in cancer to be undertaken to create a better understanding of how patients are treated
within the NHS and to target efforts to improve their outcomes.
Major resections by cancer network and sex
Male
HES linked
patients
Cancer network
N01 Lancashire and South Cumbria CN
N02 Greater Manchester and Cheshire CN
N03 Merseyside and Cheshire CN
N06 Yorkshire CN
N07 Humber and Yorkshire Coast CN
N08 North Trent CN
N11 Pan Birmingham CN
N12 Arden CN
N20 Mount Vernon CN
N21 West London CN
N22 North London CN
N23 North East London CN
N24 South East London CN
N25 South West London CN
N26 Peninsula CN
N27 Dorset CN
N28 Avon, Somerset and Wiltshire CN
N29 3 Counties CN
N30 Thames Valley CN
N31 Central South Coast CN
N32 Surrey, West Sussex and Hampshire CN
N33 Sussex CN
N34 Kent and Medway CN
N35 Greater Midlands CN
N36 North of England CN
N37 Anglia CN
N38 Essex CN
N39 East Midlands CN
England
2,760
4,114
2,791
3,279
1,480
2,286
2,715
1,138
1,195
1,412
1,547
1,310
1,177
1,372
2,961
1,423
3,140
1,398
2,477
2,539
1,075
1,472
1,656
2,049
3,781
4,167
1,435
5,791
63,940
% major
resections
8%
10%
7%
12%
10%
9%
13%
14%
7%
13%
13%
12%
10%
10%
4%
17%
12%
7%
14%
13%
11%
11%
14%
9%
9%
8%
8%
7%
10%
7%
9%
6%
11%
8%
8%
12%
12%
6%
12%
12%
10%
8%
9%
3%
15%
11%
6%
13%
12%
9%
10%
13%
7%
9%
7%
6%
7%
10%
-
HES linked
patients
18
1.8
Age-Standardised Ratio
14
12
10
8
6
4
% major
resections
95% Confidence
Interval
Networks above 99.8% Networks above 99.8% Confidence
Confidence
limit:limit:
N11, N27, N28, N30, N31 & N34
N11, N12, N27, N28, N30, N31 & 1.6
N34
1.4
1.2
1.0
0.8
0.6
Networks below 99.8% Networks below 99.8% Confidence
limit:limit:
Confidence
N01, N03, N20, N26 & N39
N01, N03, N20, N26 & N39
0.4
Networks below 99.8% Confidence limit:
N01, N03, N20, N26, N29, N37, N38 & N39
2
HES linked
patients
Indirectly age-standardised ratio: actual number of NHS treated
prostate cancer patients with a record of a major resection
divided by the expected number, by cancer network
2.0
Networks above 99.8% Confidence limit:
N06, N11, N12, N21, N22, N27, N28, N30, N31 & N34
16
Persons
95% Confidence
Interval
% major
resections
9%
11%
8%
13%
11%
10%
14%
16%
9%
15%
15%
13%
12%
12%
5%
19%
14%
9%
16%
14%
13%
13%
16%
10%
10%
9%
9%
8%
10%
Percentage of NHS treated prostate cancer patients with a record of a major resection, by cancer network
20
Percentage of patients
Female
95% Confidence
Interval
0.2
0.0
0
0
1000
2000
3000
4000
5000
0
6000
England average
200
300
400
500
600
Expected number of patients receiving a major resection
Number of HES linked patients
Cancer network
100
99.8% confidence limits
cancer network
99.8% confidence limit
The funnel plot on percentages shows that there is large variation between networks in the proportion of patients with a record of a major resection. The majority of
cancer networks fall outside the 99.8% confidence limits and therefore have a statistically significant difference from the average for England in the percentage of
patients with a record of a major resection. The funnel plot of age-standardised ratios shows less variation between cancer networks but eleven cancer networks do still
fall outside the 99.8% confidence intervals. We cannot exclude the possibility that poor quality data flowing into HES may also account for some of the differences
seen.
Note: It is important to examine the data for these networks more carefully and investigate further as to what factors may underlie the apparent differences including
coding quality within HES. The percentages shown in the table above do not take into account any factors such as differences in the age-distributions, co-morbidities
or stage at diagnosis of patients between cancer networks.
31
NHS treated patients with a record of a major resection, by sex, age and
deprivation quintile, 2004-2006, followed up to 2007
C64-C66 & C68: Kidney
Of all newly diagnosed cases of kidney cancer registered in England in 2004-2006 (excluding Death Certificate Only registrations), 92% were linked to at least one
record within HES. The results presented on these pages show the percentage of these linked, non-DCO patients who had a record of a major resection as part of their
treatment.
Using OPCS-4 codes, operations that have been defined as major resections include total and partial nephrectectomy, and total and partial excisions of the kidney. The
full list of OPCS-4 codes used for kidney cancer are included in the appendix.
These results are intending to show any differences in the percentage of NHS treated patients with a record of a major resection by different equality groups; age, sex
and deprivation. However, caution should be taken when interpreting these results due to limitations in using HES data. These results do not show the proportion of
patients who are cured of their cancer through surgery, although it is believed that the large majority of these operations will have been carried out with curative intent.
In addition, the treatment of private patients will not be captured.
Major resections by age and sex
Male
HES linked
patients
Age group
% major
resections
328
689
1,854
2,718
3,094
1,552
10,235
Under 40
40-49
50-59
60-69
70-79
80+
All ages
100%
83%
77%
73%
65%
56%
30%
60%
Female
95% Confidence
Interval
78%
74%
71%
63%
54%
27%
59%
-
HES linked
patients
86%
80%
75%
67%
57%
32%
61%
% major
resections
291
387
943
1,430
1,813
1,215
6,079
80%
80%
76%
68%
57%
27%
59%
Persons
95% Confidence
Interval
75%
76%
73%
66%
55%
25%
58%
-
HES linked
patients
84%
84%
79%
71%
60%
30%
61%
% major
resections
619
1,076
2,797
4,148
4,907
2,767
16,314
81%
78%
74%
66%
56%
29%
60%
95% Confidence
Interval
78%
76%
72%
65%
55%
27%
59%
-
84%
81%
76%
68%
58%
30%
60%
Percentage of NHS treated patients with a record of a major resection for kidney cancer, by sex and age group
90%
Percentage
ge of patients
80%
70%
60%
Male
Female
50%
40%
30%
20%
10%
0%
Under 40
40‐49
50‐59
Age group
60‐69
70‐79
80+
Major resections by deprivation quintile and sex
Male
HES linked
patients
Deprivation quintile
2,060
2,223
2,240
2,019
1,693
10,235
Quintile 1 - least deprived
Quintile 2
Quintile 3
Quintile 4
Quintile 5 - most deprived
All quintiles
% major
resections
63%
59%
60%
59%
58%
60%
Female
95% Confidence
Interval
61%
57%
58%
56%
55%
59%
-
HES linked
patients
65%
61%
62%
61%
60%
61%
% major
resections
1,132
1,239
1,279
1,259
1,170
6,079
59%
61%
60%
57%
59%
59%
Persons
95% Confidence
Interval
56%
59%
57%
54%
57%
58%
-
HES linked
patients
62%
64%
62%
60%
62%
61%
% major
resections
3,192
3,462
3,519
3,278
2,863
16,314
62%
60%
60%
58%
58%
60%
95% Confidence
Interval
60%
58%
58%
56%
57%
59%
-
63%
62%
61%
60%
60%
60%
Quintile
100%
Percentage of NHS treated patients with a record of a major resection for kidney cancer, by deprivation quintile
90%
Percentage of patients
80%
70%
60%
Male
50%
Female
40%
30%
20%
10%
0%
Least Deprived
Quintile2
Quintile3
Quintile4
Most Deprived
England
Deprivation Quintile
The difference between males and females within each age band in the percentage of patients with a record of a major resection is not statistically significant.
There is a decrease with age in the percentage of kidney cancer patients with a record of a major resection. In patients aged 50-59, 74% had a record of a major
resection compared to 56% of 70-79 year olds and 29% of patients aged 80 and over.
Across the deprivation quintiles, there was no statistically significant change in the percentage of patients with a record of a major resection for either males or females.
The percentages by deprivation quintile have not been adjusted for differences in the age structure within each quintile.
32
NHS treated patients with a record of a major resection, by sex and cancer
network, 2004-2006 followed up to 2007
C64-C66 & C68: Kidney
The results on this page are a reflection of the surgical treatment data currently available through HES, however, there are limitations in the data available and therefore
these results are being presented in order to stimulate further discussions with the clinical community as to what factors affect surgery rates and how we can improve
data collection. Differences between cancer networks maybe due to higher rates of private patients, later stage of disease at diagnosis, co-morbidities, miscoding or
poor data flow. It is important to read the introduction to this report to understand the limitations of data currently available nationally.
These results are observational; there is no "good" or "bad" percentage from these results. Better quality data are required in order to understand how surgery rates can
affect outcomes. The cancer network relates to the residence of the patient at diagnosis and not the hospital or trust where the patient was treated. Improved data
quality and consistency of coding will allow further research into inequalities in cancer to be undertaken to create a better understanding of how patients are treated
within the NHS and to target efforts to improve their outcomes.
Major resections by cancer network and sex
Male
HES linked
patients
Cancer network
324
558
370
586
281
450
292
126
180
225
220
199
222
240
475
263
467
225
430
468
215
229
306
329
749
652
281
873
10,235
N01 Lancashire and South Cumbria CN
N02 Greater Manchester and Cheshire CN
N03 Merseyside and Cheshire CN
N06 Yorkshire CN
N07 Humber and Yorkshire Coast CN
N08 North Trent CN
N11 Pan Birmingham CN
N12 Arden CN
N20 Mount Vernon CN
N21 West London CN
N22 North London CN
N23 North East London CN
N24 South East London CN
N25 South West London CN
N26 Peninsula CN
N27 Dorset CN
N28 Avon, Somerset and Wiltshire CN
N29 3 Counties CN
N30 Thames Valley CN
N31 Central South Coast CN
N32 Surrey, West Sussex and Hampshire CN
N33 Sussex CN
N34 Kent and Medway CN
N35 Greater Midlands CN
N36 North of England CN
N37 Anglia CN
N38 Essex CN
N39 East Midlands CN
England
% major
resections
63%
58%
62%
60%
58%
51%
68%
66%
67%
68%
65%
55%
64%
58%
61%
56%
52%
62%
69%
52%
52%
59%
56%
66%
61%
57%
59%
60%
60%
58%
54%
57%
56%
52%
47%
62%
57%
59%
62%
58%
48%
58%
52%
57%
49%
47%
56%
65%
48%
45%
53%
50%
61%
57%
53%
53%
56%
59%
-
HES linked
patients
68%
62%
67%
64%
64%
56%
73%
74%
73%
74%
71%
62%
70%
64%
66%
61%
56%
68%
73%
57%
59%
66%
61%
71%
64%
61%
65%
63%
61%
59%
59%
60%
61%
53%
55%
74%
74%
69%
70%
71%
59%
61%
54%
59%
55%
48%
67%
64%
55%
46%
56%
55%
67%
59%
58%
63%
56%
59%
Persons
95% Confidence
Interval
52%
53%
54%
56%
45%
49%
67%
64%
60%
61%
63%
50%
52%
46%
53%
46%
43%
59%
58%
49%
37%
49%
48%
60%
55%
53%
56%
51%
58%
-
HES linked
patients
66%
64%
67%
66%
61%
61%
80%
82%
77%
78%
78%
68%
70%
62%
65%
63%
54%
75%
70%
61%
55%
64%
61%
73%
63%
63%
70%
60%
61%
504
899
585
961
422
717
476
219
286
326
365
305
341
373
753
380
748
351
674
748
333
385
506
536
1,265
1,024
450
1,382
16,314
62%
58%
62%
61%
56%
53%
70%
69%
67%
69%
67%
57%
63%
57%
61%
55%
50%
64%
67%
53%
50%
58%
55%
66%
60%
57%
61%
58%
60%
1.8
Age-Standardised Ratio
50
66%
61%
66%
64%
61%
56%
74%
75%
73%
74%
72%
62%
68%
62%
64%
60%
54%
69%
71%
57%
55%
63%
60%
70%
63%
60%
65%
61%
60%
1.2
1.0
0.8
0.6
Networks below 99.8% Confidence limit:
N28
0.2
40
-
1.4
0.4
Networks below 99.8% Confidence limit:
N07, N28, N31 & N32
57%
55%
58%
58%
52%
49%
66%
63%
62%
63%
62%
51%
58%
52%
57%
50%
47%
59%
64%
50%
45%
53%
51%
62%
57%
54%
56%
55%
59%
Networks above 99.8% Confidence limit:
None
1.6
60
95% Confidence
Interval
% major
resections
Indirectly age-standardised ratio: actual number of NHS treated
kidney cancer patients with a record of a major resection divided
by the expected number, by cancer network
2.0
Networks above 99.8% Confidence limit:
N11, N12, N21, N30 & N35
70
% major
resections
180
341
215
375
141
267
184
93
106
101
145
106
119
133
278
117
281
126
244
280
118
156
200
207
516
372
169
509
6,079
Percentage of NHS treated kidney cancer patients with a record of a major resection, by cancer network
80
Percentage of patients
Female
95% Confidence
Interval
0.0
0
200
400
600
800
1000
1200
0
1400
England average
200
300
400
500
600
700
800
Expected number of patients receiving a major resection
Number of HES linked patients
Cancer network
100
99.8% confidence limits
cancer network
99.8% confidence limit
The funnel plot of percentages shows that nine cancer networks fall outside the 99.8% confidence limits and therefore do not have a statistically significant difference
from the average for England in the percentage of patients recorded as having a major resection. The funnel plot of age-standardised ratios between observed and
expected number of patients with a record of a major resection shows that one network falls outside the 99.8% confidence limits. We cannot exclude the possibility that
poor quality data flowing into HES may still account for some of the differences seen.
Note: It is important to examine the data for these networks more carefully and investigate further as to what other factors may underlie the apparent differences
including coding quality within HES. The percentages shown in the table above do not take into account any factors such as differences in the age-distributions, comorbidities or stage at diagnosis of patients between cancer networks.
33
NHS treated patients with a record of a major resection, by sex, age and
deprivation quintile, 2004-2006, followed up to 2007
C67: Bladder
Of all newly diagnosed cases of bladder cancer registered in England in 2004-2006 (excluding Death Certificate Only registrations), 96% were linked to at least one
record within HES. The results presented on these pages show the percentage of these linked, non-DCO patients who had a record of a major resection as part of their
treatment. For these analyses, only operations that would remove the whole tumour for bladder cancer have been included. A larger percentage of patients will
undergo other treatment for their tumour.
Using OPCS-4 codes, operations that have been defined as major resections include Cystoprostatectomy, Cystourethrectomy, Cystectomy NEC, Other specified total
excision of bladder and Unspecified total excision of bladder. Other operations such as endoscopic operations, and operations of the Urethra (that are common for
bladder cancer patients) have not been included. The full list of OPCS-4 codes used for bladder cancer are included in the appendix.
These results are intending to show any differences in the percentage of NHS treated patients with a record of a major resection by different equality groups; age, sex
and deprivation. However, caution should be taken when interpreting these results due to limitations in using HES data. These results do not show the proportion of
patients who are cured of their cancer through surgery, although it is believed that the large majority of these operations will have been carried out with curative intent.
In addition, the treatment of private patients will not be captured.
Major resections by age and sex
Male
HES linked
patients
Age group
% major
resections
95
338
1,459
3,797
6,335
4,946
16,970
Under 40
40-49
50-59
60-69
70-79
80+
All ages
100%
25%
20%
23%
17%
10%
2%
11%
Female
95% Confidence
Interval
18%
16%
21%
16%
9%
2%
10%
-
HES linked
patients
35%
24%
25%
19%
11%
2%
11%
% major
resections
60
152
496
1,167
2,078
2,639
6,592
27%
31%
20%
18%
11%
1%
10%
Persons
95% Confidence
Interval
17%
24%
17%
16%
10%
1%
9%
-
HES linked
patients
39%
39%
24%
21%
13%
2%
11%
% major
resections
155
490
1,955
4,964
8,413
7,585
23,562
26%
23%
22%
18%
10%
2%
10%
95% Confidence
Interval
20%
20%
21%
16%
10%
1%
10%
-
33%
27%
24%
19%
11%
2%
11%
Percentage of NHS treated patients with a record of a major resection for bladder cancer, by sex and age group
90%
Percentage
ge of patients
80%
70%
60%
Male
Female
50%
40%
30%
20%
10%
0%
Under 40
40‐49
50‐59
Age group
60‐69
70‐79
80+
Major resections by deprivation quintile and sex
Male
HES linked
patients
Deprivation quintile
3,196
3,601
3,673
3,522
2,978
16,970
Quintile 1 - least deprived
Quintile 2
Quintile 3
Quintile 4
Quintile 5 - most deprived
All quintiles
% major
resections
12%
11%
10%
11%
10%
11%
Female
95% Confidence
Interval
11%
10%
9%
10%
9%
10%
-
HES linked
patients
14%
12%
11%
12%
11%
11%
% major
resections
1,139
1,296
1,356
1,467
1,334
6,592
13%
10%
8%
10%
9%
10%
Persons
95% Confidence
Interval
11%
8%
7%
8%
7%
9%
-
HES linked
patients
15%
12%
10%
11%
10%
11%
% major
resections
4,335
4,897
5,029
4,989
4,312
23,562
13%
11%
9%
10%
9%
10%
95% Confidence
Interval
12%
10%
9%
10%
8%
10%
-
14%
12%
10%
11%
10%
11%
Quintile
100%
Percentage of NHS treated patients with a record of a major resection for bladder cancer, by deprivation quintile
90%
Percentage of patients
80%
70%
60%
Male
50%
Female
40%
30%
20%
10%
0%
Least Deprived
Quintile2
Quintile3
Quintile4
Most Deprived
England
Deprivation Quintile
The percentage of patients with a record of a major resection is very similar for males and females within each age band.
There is a decrease with age in the percentage of bladder cancer patients with a record of a major resection. In patients aged 50-59, 22% have a record of a major
resection compared to 10% of 70-79 year olds and 2% patients aged 80 and over.
Across the deprivation quintiles, there was no statistically significant change in the percentage of patients with a record of a major resection for either males or females.
The percentages by deprivation quintile have not been adjusted for differences in the age structure.
34
NHS treated patients with a record of a major resection, by sex and cancer
network, 2004-2006 followed up to 2007
C67: Bladder
The results on this page are a reflection of the surgical treatment data currently available through HES, however, there are limitations in the data available and therefore
these results are being presented in order to stimulate further discussions with the clinical community as to what factors affect surgery rates and how we can improve
data collection. Differences between cancer networks maybe due to higher rates of private patients, later stage of disease at diagnosis, co-morbidities, miscoding or
poor data flow. It is important to read the introduction to this report to understand the limitations of data currently available nationally.
These results are observational; there is no "good" or "bad" percentage from these results. Better quality data are required in order to understand how surgery rates can
affect outcomes. The cancer network relates to the residence of the patient at diagnosis and not the hospital or trust where the patient was treated. Improved data
quality and consistency of coding will allow further research into inequalities in cancer to be undertaken to create a better understanding of how patients are treated
within the NHS and to target efforts to improve their outcomes.
Major resections by cancer network and sex
Male
HES linked
patients
Cancer network
N01 Lancashire and South Cumbria CN
N02 Greater Manchester and Cheshire CN
N03 Merseyside and Cheshire CN
N06 Yorkshire CN
N07 Humber and Yorkshire Coast CN
N08 North Trent CN
N11 Pan Birmingham CN
N12 Arden CN
N20 Mount Vernon CN
N21 West London CN
N22 North London CN
N23 North East London CN
N24 South East London CN
N25 South West London CN
N26 Peninsula CN
N27 Dorset CN
N28 Avon, Somerset and Wiltshire CN
N29 3 Counties CN
N30 Thames Valley CN
N31 Central South Coast CN
N32 Surrey, West Sussex and Hampshire CN
N33 Sussex CN
N34 Kent and Medway CN
N35 Greater Midlands CN
N36 North of England CN
N37 Anglia CN
N38 Essex CN
N39 East Midlands CN
England
696
1,022
700
900
490
643
541
294
362
403
359
369
374
448
673
362
682
374
690
731
326
398
639
609
1,109
927
493
1,356
16,970
Female
95% Confidence
Interval
% major
resections
10%
10%
8%
12%
6%
12%
10%
10%
11%
12%
11%
7%
10%
12%
6%
6%
12%
15%
15%
12%
12%
13%
13%
11%
9%
12%
11%
10%
11%
8%
9%
6%
10%
4%
10%
8%
7%
8%
10%
8%
5%
7%
9%
4%
4%
10%
12%
13%
10%
9%
10%
11%
9%
7%
10%
9%
8%
10%
-
HES linked
patients
12%
12%
10%
14%
9%
15%
13%
14%
14%
16%
15%
10%
13%
15%
8%
9%
15%
19%
18%
15%
16%
16%
16%
14%
11%
15%
14%
12%
11%
257
433
297
409
185
298
189
103
125
195
122
151
137
181
264
114
233
127
252
270
122
166
212
233
477
322
190
528
6,592
Percentage of NHS treated bladder cancer patients with a record of a major resection, by cancer network
6%
5%
4%
11%
5%
7%
9%
7%
5%
10%
2%
4%
4%
9%
6%
1%
7%
9%
8%
9%
6%
6%
4%
9%
7%
9%
10%
6%
9%
-
HES linked
patients
13%
9%
10%
18%
13%
14%
19%
19%
15%
19%
10%
12%
13%
18%
12%
9%
15%
20%
16%
17%
16%
14%
11%
17%
12%
16%
20%
10%
11%
953
1,455
997
1,309
675
941
730
397
487
598
481
520
511
629
937
476
915
501
942
1,001
448
564
851
842
1,586
1,249
683
1,884
23,562
10
95% Confidence
Interval
8%
8%
6%
11%
5%
10%
9%
8%
8%
10%
7%
5%
7%
10%
5%
4%
10%
12%
12%
10%
9%
9%
10%
9%
8%
11%
10%
8%
10%
-
12%
11%
9%
15%
9%
14%
13%
14%
13%
16%
12%
9%
12%
15%
8%
8%
14%
18%
17%
15%
15%
14%
14%
14%
10%
14%
15%
11%
11%
1.4
1.2
1.0
0.8
0.6
Networks below 99.8% Confidence limit:
N03, N07, N26 & N27
0.2
0
10%
9%
7%
13%
7%
11%
11%
11%
10%
13%
9%
7%
9%
12%
6%
5%
12%
15%
14%
12%
12%
12%
12%
11%
9%
12%
12%
9%
10%
Networks above 99.8% Confidence limit:
N30
1.6
0.4
Networks below 99.8% Confidence limit:
N03, N07, N26 & N27
% major
resections
Indirectly age-standardised ratio: actual number of NHS treated
bladder cancer patients with a record of a major resection divided
by the expected number, by cancer network
2.0
Age-Standardised Ratio
Percentage of patients
9%
7%
6%
14%
8%
10%
13%
12%
9%
14%
5%
7%
7%
13%
8%
4%
10%
13%
12%
12%
10%
9%
7%
12%
9%
12%
14%
8%
10%
Persons
95% Confidence
Interval
1.8
Networks above 99.8% Confidence limit:
N30
20
% major
resections
0.0
0
500
1000
1500
0
2000
Cancer network
England average
50
100
150
200
Expected number of patients receiving a major resection
Number of HES linked patients
cancer network
99.8% confidence limits
99.8% confidence limit
The funnel plot of percentages shows that five cancer networks fall outside the 99.8% confidence limits and therefore the difference from the average for England in the
percentage of patients recorded as having a major resection is statistically significant for these cancer networks. The plot for the age-standardised ratio shows that
when taking into account differences in the age structures of the networks, the same five cancer networks do fall outside the 99.8% confidence limit. We cannot
exclude the possibility that poor quality data flowing into HES may account for some of the differences seen.
Note: It is important to examine the data for these networks more carefully and investigate further as to what factors may underlie the apparent differences including
coding quality within HES. The percentages shown in the table above do not take into account any factors such as differences in the age-distributions, co-morbidities
or stage at diagnosis of patients between cancer networks.
35
Glossary
Death Certificate Only (DCO)
Patients whose diagnosis is solely on the basis of the existence of a death certificate with cancer as a
cause of death.
Denominator
Only patients with at least one linked record within HES were included as the denominator. The
number of linked patients is less than the total number of patients diagnosed. As no information is
known about patients without a linked HES record, it has been assumed that they were not treated
within an NHS hospital for their cancer and therefore are not included in this analysis.
95% confidence intervals
For the percentages, 95% confidence intervals are given calculated using the Wilson Score Method.
These are a measure of variability in the percentages calculated using the sample size. The upper and
lower limits of the confidence interval show how big a contribution chance may have made to a
particular statistic. The 95% confidence intervals quoted give the range in which the rate in question
would fall 19 times out of 20, were it possible to repeat the analyses.
Indirectly age-standardised ratios
Age-standardised ratios for cancer networks were calculated using the indirect method. 1 The number
of patients recorded with a major resection is divided by the number of patients expected to have
received a major resection, given the age distribution of the patients for each network. The expected
number is calculated by using the percentages calculated for all patients in England, by age groups, for
each site.
Percentages by deprivation
Weighted ordinary least squares linear regression was used to model the trend across percentages for
deprivation quintiles. The weight used for the linear regression was the corresponding number of
patients for each quintile.
Funnel plots and 99.8% limits
Non-age-standardised funnel plots are created to compare the percentage of patients with a record of
a major resection for the 28 cancer networks with the overall percentage for England. They show how
the networks compare by looking at whether the percentage is above, below or within the 99.8%
control limits around the overall percentage for England.
The percentages for each cancer network are plotted against the number of HES linked patients within
each network to take into account the varying number of patients in each of the cancer networks.
1
Statistical Methods in Cancer Research, Volume IV – Descriptive Epidemiology, IARC Scientific Publications
No.128, pp62
36
Only those networks whose percentage lie outside the control limits are highlighted because they
appear to have a difference in the percentage with a record of a major resection that is statistically
significant.
These differences warrant further investigation as the difference may well be affected by data quality
issues in HES as well as the linking between cancer registrations and the HES database.
Funnel plots for indirectly age-standardised resection ratios show the ratios plotted against the
expected number of patients with a record of a major resection (see Indirectly age-standardised ratios).
These funnel plots show which networks fall outside the limits once differences in the age structure of
the group of patients has been taken into account.
Excel sheet templates and explanations of funnel plots are available from the APHO website or from
ERPHO 2
It is important to note that the results for each cancer network relates to the postcode of residence of
patients and not the cancer network where the patient is treated.
SSCRGs
The Site Specific Clinical Reference Groups bring together clinical specialists, cancer registries, patient
and charity representatives in order to advise, support and shape the work of the NCIN.
More information can be found on the NCIN website www.ncin.org.uk
OPCS classification
Operations and procedures within HES are recorded using the OPCS Classification of Interventions and
Procedures. For more information please see www.connectingforhealth.nhs.uk/clinicalcoding
Major resection
A major resection has been defined with SSCRG lead clinicians as an operation which would be carried
out for a cancer patient which would attempt to remove the entire tumour. A list of OPCS-4 codes
assigned as major resections for each site are available in Appendix 2.
2
http://www.erpho.org.uk/ViewResource.aspx?id=16120
37
Appendix 1: Percentage of patients linked to at least one record within HES, by site and cancer network, 2004-2006
This table shows the percentage of non-DCO cancer registrations that were linked to HES. Percentages linked for prostate cancer are low due to the relatively high number of patients
who are not treated as an inpatient or day case and therefore do not have a record in HES. This table is included to show the proportion of patients that a HES record was available for
and included in the analyses for each network.
Oesophagus
Upper GI
Stomach
Liver
Pancreas
Colorectal
Lung
Breast
Gynaecological
Cervix
Uterus
Ovary
Prostate
Urology
Kidney
Bladder
N01 Lancashire and South Cumbria CN
N02 Greater Manchester and Cheshire CN
N03 Merseyside and Cheshire CN
N06 Yorkshire CN
N07 Humber and Yorkshire Coast CN
N08 North Trent CN
N11 Pan Birmingham CN
N12 Arden CN
N20 Mount Vernon CN
N21 West London CN
N22 North West London CN
N23 North East London CN
N24 South East London CN
N25 South West London CN
N26 Peninsula CN
N27 Dorset CN
N28 Avon, Somerset and Wiltshire CN
N29 3 Counties CN
N30 Thames Valley CN
N31 Central South Coast CN
N32 Surrey, West Sussex and Hampshire CN
N33 Sussex CN
N34 Kent and Medway CN
N35 Greater Midlands CN
N36 North of England CN
N37 Anglia CN
N38 Essex CN
N39 East Midlands CN
98%
96%
97%
96%
99%
98%
98%
97%
97%
95%
94%
95%
95%
96%
97%
99%
97%
95%
95%
95%
94%
96%
93%
95%
98%
98%
97%
99%
95%
96%
94%
96%
96%
98%
96%
96%
92%
91%
93%
93%
93%
92%
94%
97%
96%
94%
92%
92%
93%
95%
93%
95%
97%
94%
96%
97%
91%
94%
91%
86%
89%
93%
92%
94%
84%
88%
90%
91%
88%
87%
93%
93%
90%
96%
88%
88%
80%
89%
83%
88%
90%
91%
87%
94%
91%
94%
92%
92%
93%
97%
98%
95%
83%
92%
87%
92%
88%
88%
93%
95%
92%
94%
89%
93%
87%
90%
87%
89%
94%
92%
91%
96%
96%
95%
94%
95%
96%
96%
95%
95%
92%
93%
91%
94%
93%
92%
95%
95%
96%
95%
91%
94%
92%
92%
90%
94%
97%
94%
95%
97%
95%
93%
91%
90%
93%
96%
94%
94%
88%
91%
88%
91%
90%
88%
93%
94%
92%
92%
88%
90%
88%
90%
87%
90%
92%
92%
93%
96%
95%
91%
89%
88%
88%
91%
90%
89%
79%
84%
83%
88%
85%
84%
92%
89%
88%
90%
82%
89%
81%
86%
83%
90%
93%
88%
85%
91%
93%
94%
92%
89%
86%
90%
91%
90%
85%
91%
90%
90%
90%
86%
95%
89%
84%
82%
89%
91%
92%
84%
76%
94%
83%
83%
94%
90%
93%
93%
92%
88%
93%
96%
91%
91%
81%
89%
93%
92%
85%
83%
94%
92%
95%
90%
87%
92%
86%
90%
88%
92%
93%
90%
93%
94%
93%
93%
88%
88%
91%
93%
91%
88%
86%
89%
88%
92%
86%
91%
94%
96%
94%
92%
87%
95%
85%
86%
89%
91%
92%
91%
94%
93%
89%
76%
78%
70%
74%
86%
80%
66%
68%
67%
72%
74%
64%
60%
83%
63%
83%
65%
60%
65%
65%
72%
60%
61%
78%
75%
62%
82%
95%
94%
91%
92%
95%
94%
92%
95%
89%
91%
88%
93%
91%
87%
95%
92%
91%
89%
87%
94%
94%
93%
90%
90%
96%
93%
93%
94%
97%
96%
97%
95%
99%
97%
97%
98%
95%
94%
95%
96%
96%
93%
97%
96%
97%
95%
94%
96%
94%
93%
95%
95%
97%
96%
96%
98%
England
97%
95%
90%
92%
94%
92%
88%
89%
91%
91%
73%
92%
96%
38
Appendix 2: OPCS-4 codes assigned as a major resection by cancer site
Oesophagus
Code
G011
G018
G019
G021
G022
G023
G024
G025
G028
G029
G031
G032
G035
G036
G038
G039
Description
Oesophagogastrectomy and anastomosis of oesophagus to stomach
Other specified excision of oesophagus and stomach
Unspecified excision of oesophagus and stomach
Total oesophagectomy and anastomosis of pharynx to stomach
Total oesophagectomy and interposition of microvascularly attached jejunum
Total oesophagectomy and interposition of jejunum NEC
Total oesophagectomy and interposition of microvascularly attached colon
Total oesophagectomy and interposition of colon NEC
Other specified total excision of oesophagus
Unspecified total excision of oesophagus
Partial oesophagectomy and end to end anastomosis of oesophagus
Partial oesophagectomy and interposition of microvascularly attached jejunum
Partial oesophagectomy and interposition of microvascularly attached colon
Partial oesophagectomy and interposition of colon NEC
Other Specified partial excision
Unspecified partial excision
Stomach
Code
G012
G013
G271
G272
G273
G274
G275
G278
G281
G282
G283
G288
Liver
Code
J021
J022
J023
J024
J026
J027
J028
J029
Description
Oesophagogastrectomy and anastomosis of oesophagus to transposed jejunum
Oesophagogastrectomy and anastomosis of oesophagus to jejunum NEC
Total gastrectomy and excision of surrounding tissue
Total gastrectomy and anastomosis of oesophagus to duodenum
Total gastrectomy and interposition of jejunum
Total gastrectomy and anastomosis of oesophagus to transposed jejunum
Total gastrectomy and anastomosis of oesophagus to jejunum NEC
Total excision of stomach, Other specified
Partial gastrectomy and anastomosis of stomach to duodenum
Partial gastrectomy and anastomosis of stomach to transposed jejunum
Partial gastrectomy and anastomosis of stomach to jejunum NEC, Billroth II
Partial excision of stomach, other specified
Description
Right hemihepatectomy
Left hemihepatectomy
Resection of segment(s) of liver
Wedge excision of liver
Extended right hemihepatectomy
Extended left hemihepatectomy
Other specified partial excision of liver
Partial excision of liver, Unspecified
39
Pancreas
Code
J551
J552
J558
J559
J561
J562
J563
J564
J568
J569
J571
J572
J573
J574
J575
J578
J579
Description
Total pancreatectomy and excision of surrounding tissue
Total pancreatectomy NEC
Other specified total excision of pancreas
Unspecified total excision of pancreas
Pancreaticoduodenectomy and excision of surrounding tissue
Pancreaticoduodenectomy and resection of antrum of stomach
Pancreaticoduodenectomy NEC
Subtotal excision of head of pancreas with preservation of duodenum and drainage HFQ
Pylorus-preserving Pancreaticoduodenectomy. Excision of head of pancreas, other
specified.
Excision of head of pancreas, unspecified.
Subtotal pancreatectomy
Left pancreatectomy and drainage of pancreatic duct
Left pancreatectomy NEC
Excision of tail of pancreas and drainage of pancreatic duct
Excision of tail of pancreas NEC
Other specified other partial excision of pancreas
Other partial excision of pancreas, unspecified. Pancreatectomy nos
Colorectal
Code
H041
H042
H043
H048
H049
H051
H052
H053
H058
H059
H061
H062
H063
H064
H068
H069
H071
H072
H073
H074
H078
H079
H081
H082
H083
H084
H085
H088
H089
H091
H092
H093
H094
H095
H098
Description
Proctocolectomy NEC, Panproctocolectomy and Ileostomy
Panproctocolectomy and anastomosis of ileum to anus and creation of pouch HFQ
Panproctocolectomy and anastomosis of ileum to anus NEC
Other specified total excision of colon and rectum
Panproctocolectomy NEC, Total excision of colon and rectum, unspecifiedTotal colectomy and anastomosis of ileum to rectum
Total colectomy and ileostomy and creation of rectal fistula HFQ
Total colectomy and ileostomy NEC
Total excision of colon, other specified
Total excision of colon, Unspecified
Extended right hemicolectomy and end to end anastomosis
Extended right hemicolectomy and anastomosis of ileum to colon
Extended right hemicolectomy and anastomosis NEC
Extended right hemicolectomy and ileostomy HFQ
Other specified extended excision of right hemicolon
Extended excision of Right hemicolon, unspecified, excision of Right colon and surrounding tissue
Right hemicolectomy and end to end anastomosis of ileum to colon, Ileocaecal resection
Right hemicolectomy and side to side anastomosis of ileum to transverse colon,
Right hemicolectomy and anastomosis NEC
Right hemicolectomy and ileostomy HFQ
Other specified other excision of right hemicolon
Other excision of right hemicolon, unspecified; Right hemicolectomy NEC
Transverse colectomy and end to end anastomosis
Transverse colectomy and anastomosis of ileum to colon
Transverse colectomy and anastomosis NEC
Transverse colectomy and ileostomy HFQ
Transverse colectomy and exteriorisation of bowel NEC
Other specified excision of transverse colon
Excision of transverse colon, unspecified
Left hemicolectomy and end to end anastomosis of colon to rectum
Left hemicolectomy and end to end anastomosis of colon to colon
Left hemicolectomy and anastomosis NEC
Left hemicolectomy and ileostomy HFQ
Left hemicolectomy and exteriorisation of bowel NEC
Excision of left hemicolon, Other specified 40
H099
H101
H102
H103
H104
H105
H108
H109
H111
H112
H113
H114
H115
H118
H119
H291
H292
H293
H294
H298
H299
H331
H332
H333
H334
H335
H336
H337
H338
H339
H404
H408
H409
X141
X142
X143
X148
X149
Left hemicolectmy NEC, Excision of left hemicolon, Unspecified
Sigmoid colectomy and end to end anastomosis of ileum to rectum
Sigmoid colectomy and anastomosis of colon to rectum
Sigmoid colectomy and anastomosis NEC
Sigmoid colectomy and ileostomy HFQ
Sigmoid colectomy and exteriorisation of bowel NEC
Other specified excision of sigmoid colon
Unspecified excision of sigmoid colon
Colectomy and end to end anastomosis of colon to colon NEC
Colectomy and side to side anastomosis of ileum to colon NEC
Colectomy and anastomosis NEC
Colectomy and ileostomy NEC
Colectomy and exteriorisation of bowel
Other excision of colon, other specified
Hemicolectomy NEC; Colectomy NEC, Other excision of colon, unspecified;
Subtotal excision of colon and rectum and creation of colonic pouch and anastomosis of colon to anus
Subtotal excision of colon and rectum and creation of colonic pouch NEC
Subtotal excision of colon and creation of colonic pouch and anastomosis of colon to rectum
Subtotal excision of colon and creation of colonic pouch NEC
Subtotal excision of colon, Other specified
Subtotal excision of colon, Unspecified
Abdominoperineal excision of rectum and end colostomy; APR; SCAPER
Proctectomy and anastomosis of colon to anus
Anterior resection of rectum and anastomosis of colon to rectum using staples
Anterior resection of rectum and anastomosis NEC
Hartmann procedure, Rectosigmoidectomy and closure of rectal stump and exteriorisation of bowel
Anterior resection of rectum and exteriorisation
Perineal resection of rectum HFQ
Anterior Resection of Rectum NEC
Rectosigmoidectomy NEC, Excision of rectum, unspecified
Trans-sphincteric anastomosis of colon to anus
Other specified operations on rectum through anal sphincter
Unspecified operations on rectum through anal sphincter
Total exenteration of pelvis
Anterior exenteration of pelvis
Posterior exenteration of pelvis
Other specified clearance of pelvis
Clearance of pelvis, unspecified
Lung
Code
E391
E398
E399
E441
E461
E541
E542
E543
E544
E545
E548
E549
E552
E559
T013
T023
Description
Open excision of lesion of trachea
Other specified partial excision of trachea
Unspecified partial excision of trachea
Excision of carina
Sleeve resection of bronchus and anastomosis HFQ
Total pneumonectomy, total removal of lung, Pneumonectomy NEC
Bilobectomy of lung
Lobectomy of lung
Excision of segment of lung
Partial lobectomy of lung NEC
Excision of lung, other specified
Excision of lung, Unspecified
Open excision of lesion of lung
Open removal of lesion of lung, unspecified
Excision of lesion of chest wall
Insertion of prothesis into chest wall NEC
41
Breast
Code
B271
B272
B273
B274
B275
B276
B278
B279
B281
B282
B283
B284
B285
B286
B288
B289
B341
B342
B343
B352
B353
B374
B401
B408
B409
Description
Total mastectomy and excision of both pectoral muscles and part of chest wall
Radical mastectomy/total mastectomy and excision of both pectoral muscles NEC.
Total mastectomy and excision of pectoralis minor muscle
Total mastectomy NEC, inc toilet and simple mastectomy, extended simple mastectomy.
Subcutaneous mastectomy
Skin sparing mastectomy
Total excision of breast other specified.
Unspecified, Mastectomy NEC.
Quadrantectomy of breast
Partial excision of breast, Partial mastectomy, WLE, includes wedge or segmental excision of breast NEC.
Excision of lesion of breast, includes lumpectomy, excision biopsy.
Re-excision of breast margins
Wire guided partial excision of breast
Excision of accessory breast tissue
Other specified other excision of breast
Unspecified other excision of breast
Subareolar excision of mammillary duct
Excision of mammillary duct NEC
Excision of lesion of mammillary duct nec. Microdochectomy.
Excision of nipple
Extirpation/removal of lesion of nipple.
Capsulectomy of breast
Interstitial laser destruction of lesion of breast
Destruction of lesion of breast, Other specified
Destruction of lesion of breast, Unspecified
Cervix
Code
P172
Q011
Q013
Q018
Q071
Q072
Q073
Q074
Q078
Q079
Q081
Q082
Q083
Q088
Q089
X141
X142
X143
Description
Excision of Vagina
Amputation of Cervix, Radical Trachelectomy
Excision of cervix uteri, Lesion of
Excision of cervix uteri, Other specified
Radical Hysterectomy (removes uterus + cervix + vagina). Wertheims hysterectomy
Abdominal Hysterectomy and excision of periuterine tissue NEC.Radical Hysterectomy
Abdominal excision of Uterus
TAH, Panhysterectomy, hysterectomy NEC (removes uterus + cervix). Total abdominal
hysterectomy NEC
Other specified abdominal excision of uterus
Abdominal excision of Uterus, unspecified
Vaginal hysterocolpectomy and excision of periuterine tissue
Vaginal hysterectomy and excision of periuterine tissue NEC
Vaginal hysterocolpectomy NEC
Vaginal excision of Uterus
Unspecified vaginal excision of uterus
Clearance of Pelvis, total exenteration
Clearance of Pelvis, anterior exenteration
Clearance of Pelvis, posterior exenteration
42
Ovary
Code
Q071
Q072
Q073
Q074
Q075
Q078
Q079
Q081
Q082
Q083
Q088
Q089
Q243
Q223
Q235
Q491
Q236
Q438
Q439
Q232
Q241
Q221
Q231
T361
X141
X142
X143
Description
Radical Hysterectomy (removes uterus + cervix + vagina). Wertheims hysterectomy
Abdominal Hysterectomy and excision of periuterine tissue NEC.Radical Hysterectomy
Abdominal excision of Uterus, abdominal hysterocolpectomy nec
TAH, Panhysterectomy, hysterectomy NEC (removes uterus + cervix). Total abdominal hysterectomy NEC
Abdominal excision of Uterus, subtotal abdominal hysterocolpectomy
Abdominal excision of uterus, other specified
Abdominal excision of uterus, Unspecified
Vaginal excision of uterus, vaginal hysterocolpectomy
Vaginal excision of uterus, vaginal hysterectomy
Vaginal excision of uterus, vaginal hysterocolpectomy NEC
Vaginal excision of uterus, other specified
Vaginal excision of Uterus, Unspecified
Oophorectomy NEC
Bilateral oophorectomy, excision of gonads
Unilateral oophorectomy NEC
Endoscopic extirpation of lesion of ovary NEC
Oophorectomy of remaining solitary ovary NEC
Other specified partial excision of ovary
Unspecified partial excision of ovary
Salpingoophorectomy of remaining solitary fallopian tube and ovary
Salpingoophorectomy NEC
Bilateral salpingoophorectomy
Unilateral salpingoophorectomy NEC
Omentectomy
Clearance of Pelvis, total exenteration
Clearance of Pelvis, Anterior exenteration
Clearance of Pelvis, Posterior exenteration
Uterus
Code
Q071
Q072
Q073
Q074
Q079
Q081
Q082
Q083
Q088
Q089
Q078
Q075
Q093
Q161
Q229
Q239
Q521
X141
X142
X143
Description
Radical Hysterectomy (removes uterus + cervix + vagina). Wertheims hysterectomy
Abdominal Hysterectomy and excision of periuterine tissue NEC.Radical Hysterectomy
Abdominal hysterocolpectomy NEC, Hysterocolpectomy NEC
TAH, Panhysterectomy, hysterectomy NEC (removes uterus + cervix). Total abdominal hysterectomy NEC
Abdonimal excision of uterus, unspecified
Vaginal hysterocolpectomy and excision of periuterine tissue
Vaginal hysterectomy and excision of periuterine tissue NEC
Vaginal hysterocolpectomy NEC
Vaginal Excision of Uterus, other specified
Unspecified vaginal excision of uterus
Other specified abdominal excision of uterus
Subtotal abdominal Hysterectomy (does not remove cervix)
Open excision of lesion of uterus NEC
Other vaginal operations on uterus, vaginal excision of lesion of uterus
Bilateral Excision of adnexa of uterus unspecified
Unspecified unilateral excision of adnexa of uterus
Excision of lesion of broad ligament of uterus
Clearance of pelvis, Total exenteration
Clearance of pelvis, Anterior exenteration
Clearance of pelvis, Posterior exenteration
43
Prostate
Code
M611
M614
M618
M619
Description
Total / Radical prostatectomy, Total excision of prostate and capsule
Perineal prostatectomy
Open excision of prostate, other specified
Prostatectomy NEC. Open excision of prostate, unspecified
Bladder
Code
M341
M342
M343
M348
M349
Description
Cystoprostatectomy
Cystourethrectomy
Cystectomy NEC
Other specified total excision of bladder
Unspecified total excision of bladder
Kidney
Code
M021
M022
M023
M024
M025
M028
M029
M038
M039
M042
M104
M181
M182
M183
M252
Description
Nephrectomy and excision of perirenal tissue, Nephroureterectomy and excision of perirenal tissue
Nephroureterectomy NEC
Bilateral nephrectomy
Excision of half of horseshoe kidney
Nephrectomy NEC
Total excision of kidney, other specified
Total excision of kidney, unspecified
Other specified partial excision of kidney
Partial nephrectomy NEC, Partial excision of kidney, Unspecified
Open excision of lesion of kidney NEC
Endoscopic cryoablation of lesion of kidney
Total ureterectomy , Ureterectomy NEC
Excision of segment of ureter
Secondary ureterectomy
Open excision of lesion of ureter NEC
44
March 2011
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