TY - JOUR
T1 - The influence of hospital volume on long-term oncological outcome after rectal cancer surgery
AU - Jonker, Frederik H. W.
AU - Hagemans, Jan A. W.
AU - Burger, Jacobus W. A.
AU - Verhoef, Cornelis
AU - Borstlap, Wernard A. A.
AU - Dutch Snapshot Res Grp
AU - Bouvy, Nicole
AU - Tanis, Pieter J.
PY - 2017/12
Y1 - 2017/12
N2 - The association between hospital volume and outcome in rectal cancer surgery is still subject of debate. The purpose of this study was to assess the impact of hospital volume on outcomes of rectal cancer surgery in the Netherlands in 2011.In this collaborative research with a cross-sectional study design, patients who underwent rectal cancer resection in 71 Dutch hospitals in 2011 were included. Annual hospital volume was stratified as low (<20), medium (20-50), and high (ae 50).Of 2095 patients, 258 patients (12.3%) were treated in 23 low-volume hospitals, 1329 (63.4%) in 40 medium-volume hospitals, and 508 (24.2%) in 8 high-volume hospitals. Median length of follow-up was 41 months. Clinical tumor stage, neoadjuvant therapy, extended resections, circumferential resection margin (CRM) positivity, and 30-day or in-hospital mortality did not differ significantly between volume groups. Significantly, more laparoscopic procedures were performed in low-volume hospitals, and more diverting stomas in high-volume hospitals. Three-year disease-free survival for low-, medium-, and high-volume hospitals was 75.0, 74.8, and 76.8% (p = 0.682). Corresponding 3-year overall survival rates were 75.9, 79.1, and 80.3% (p = 0.344). In multivariate analysis, hospital volume was not associated with long-term risk of mortality.No significant impact of hospital volume on rectal cancer surgery outcome could be observed among 71 Dutch hospitals after implementation of a national audit, with the majority of patients being treated at medium-volume hospitals.
AB - The association between hospital volume and outcome in rectal cancer surgery is still subject of debate. The purpose of this study was to assess the impact of hospital volume on outcomes of rectal cancer surgery in the Netherlands in 2011.In this collaborative research with a cross-sectional study design, patients who underwent rectal cancer resection in 71 Dutch hospitals in 2011 were included. Annual hospital volume was stratified as low (<20), medium (20-50), and high (ae 50).Of 2095 patients, 258 patients (12.3%) were treated in 23 low-volume hospitals, 1329 (63.4%) in 40 medium-volume hospitals, and 508 (24.2%) in 8 high-volume hospitals. Median length of follow-up was 41 months. Clinical tumor stage, neoadjuvant therapy, extended resections, circumferential resection margin (CRM) positivity, and 30-day or in-hospital mortality did not differ significantly between volume groups. Significantly, more laparoscopic procedures were performed in low-volume hospitals, and more diverting stomas in high-volume hospitals. Three-year disease-free survival for low-, medium-, and high-volume hospitals was 75.0, 74.8, and 76.8% (p = 0.682). Corresponding 3-year overall survival rates were 75.9, 79.1, and 80.3% (p = 0.344). In multivariate analysis, hospital volume was not associated with long-term risk of mortality.No significant impact of hospital volume on rectal cancer surgery outcome could be observed among 71 Dutch hospitals after implementation of a national audit, with the majority of patients being treated at medium-volume hospitals.
KW - Rectal cancer
KW - Hospital volume
KW - Surgery
KW - Outcome
KW - SPANISH ASSOCIATION
KW - RESECTION
KW - SURVIVAL
KW - IMPACT
KW - MORTALITY
KW - PROJECT
U2 - 10.1007/s00384-017-2889-2
DO - 10.1007/s00384-017-2889-2
M3 - Article
C2 - 28884251
SN - 0179-1958
VL - 32
SP - 1741
EP - 1747
JO - International Journal of Colorectal Disease
JF - International Journal of Colorectal Disease
IS - 12
ER -