The influence of hospital volume on long-term oncological outcome after rectal cancer surgery

• Published in: International journal of colorectal disease Vol. 32; no. 12; pp. 1741 - 1747
• Main Authors: Jonker, Frederik H. W., Hagemans, Jan A. W., Burger, Jacobus W. A., Verhoef, Cornelis, Borstlap, Wernard A. A., Tanis, Pieter J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2017; Springer; Springer Nature B.V
• Subjects: Adjuvant treatment; Aged; Analysis; Cancer; Cancer patients; Cancer surgery; Care and treatment; Chi-Square Distribution; Colorectal cancer; Cross-Sectional Studies; Digestive System Surgical Procedures - adverse effects; Digestive System Surgical Procedures - mortality; Digestive System Surgical Procedures - trends; Disease-Free Survival; Female; Gastroenterology; Health aspects; Health risk assessment; Hepatology; Hospital Mortality - trends; Hospitals; Hospitals, High-Volume - trends; Hospitals, Low-Volume - trends; Humans; Internal Medicine; Kaplan-Meier Estimate; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - mortality; Laparoscopy - trends; Male; Margins of Excision; Medicine; Medicine & Public Health; Middle Aged; Mortality; Multivariate Analysis; Neoadjuvant Therapy - trends; Neoplasm Staging; Neoplasm, Residual; Netherlands; Oncology, Experimental; Original Article; Process Assessment (Health Care) - trends; Proctology; Proportional Hazards Models; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Rectum; Registries; Risk Factors; Surgery; Surgical Stomas - adverse effects; Surgical Stomas - trends; Survival; Time Factors; Treatment Outcome; Hospital volume; Rectal cancer; Surgery; Outcome
• ISSN: 0179-1958; 1432-1262; 1432-1262
• DOI: 10.1007/s00384-017-2889-2

Purpose 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. Methods 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 (≥ 50). Results 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. Conclusions 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.