Volume and outcome in rectal cancer surgery: the importance of quality management
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For many years, the impact of the surgeon volume on short- and long-term outcome after rectal carcinoma surgery is controversially discussed. Literature and own department data were reviewed in order to clarify the impact of surgeon volume in the current era of total mesorectal excision surgery, multimodal therapy, quality management, and centralization of cancer care.
Uni- and multivariate analysis of data from 1,028 patients with solitary rectal carcinoma, treated between 1995 and 2010 at the Department of Surgery, University Hospital, Erlangen, Germany, was performed. Surgeons were subdivided according to the number of operations/year into high- (at least seven/year), medium- (three to six), and low- (less than three) volume surgeons.
Of 1,028 patients, 800 (77.8 %) were operated by five high-volume surgeons, 193 (18.8 %) by seven medium-volume surgeons, and 35 (3.4 %) by 12 low-volume surgeons. Surgeon volume was significantly associated with postoperative mortality and the rate of positive pathological circumferential resection margin. In risk-adjusted analysis, after primary surgery, surgeon volume had a significant impact on observed overall survival and disease-free survival, but not on locoregional recurrence. After neoadjuvant radiochemotherapy, only observed overall survival was significantly influenced by surgeon volume.
In surgical departments with special interest in rectal carcinoma, surgeon volume has some influence on short- and long-term outcome. Irrespective of this fact, specialization, experience, individual skill, hospital organization, and regular quality assurance are essential prognostic factors ensuring good results in rectal carcinoma surgery.
KeywordsLong-term outcome Quality management Rectal carcinoma Short-term outcome Surgeon volume TME (Total mesorectal excision) surgery
- 1.Meagher AP (1999) Colorectal cancer: is the surgeon a prognostic factor? A systematic review. Med J Aust 20(171):308–310Google Scholar
- 6.Archampong D, Borowski D, Wille-Jørgensen P, Iversen LH (2012) Workload and surgeon's specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev. 2012;3:CD005391Google Scholar
- 8.Gospodarowicz MK, O'Sullivan B (2001) Prognostic factors: principles and application. In: Gospodarowicz MK, Henson DE, Hutter RVP, O'Sullivan B, Sobin L, Wittekind CH (eds) UICC. Prognostic factors in Cancer. 2nd ed. Wiley, New York, pp 17–35Google Scholar
- 10.Hobday TJ, Erlichman CE (2001) Colorectal cancer. In: Gospodarowicz MK, Henson DE, Hutter RVP, O'Sullivan B, Sobin L, Wittekind C (eds) UICC. Prognostic factors in Cancer. 2nd ed. Wiley, New York, pp 267–279Google Scholar
- 11.Compton CC (2006) Colorectal cancer. In: Gospodarowicz MK, O’Sullivan B, Sobin LH (eds) UICC. Prognostic factors in cancer, 3rd ed. Wiley, New York, pp 133–137Google Scholar
- 12.Archampong D, Borowski DW (2012) Impact of hospital volume on outcomes of rectal cancer surgery: a systematic review and meta-analysis. Int J Colorectal Dis in pressGoogle Scholar
- 17.Rödel C, Liersch T, Becker H et al (2012) Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol 13:679–687PubMedCrossRefGoogle Scholar
- 19.UICC (2009) TNM classification of malignant tumors. 7th ed. (Sobin LH, Gospodarowicz MK, Wittekind Ch, eds) Wiley, Oxford, UKGoogle Scholar
- 36.German Cancer Society [Deutsche Krebsgesellschaft] (2012) Erhebungsbogen für Darmkrebszentren der Deutschen Krebsgesellschaft. http://www.onkozert.de/downloads/eb_darm-C1(03.12.2010).doc. Accessed 28 August 2012