Abstract
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.
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Acknowledgements
Collaborators: A Aalbers, Y Acherman, GD Algie, B Alting von Geusau, F Amelung, TS Aukema, IS Bakker, SA Bartels, S Basha, AJNM Bastiaansen, E Belgers, WA Bemelman, W Bleeker, J Blok, RJI Bosker, JW Bosmans, MC Boute, ND Bouvy, H Bouwman, A Brandt-Kerkhof, DJ Brinkman, S Bruin, ERJ Bruns, JPM Burbach, S Clermonts, PPLO Coene, C Compaan, ECJ Consten, T Darbyshire, SML de Mik, EJR de Graaf, I de Groot, RJL de vos tot Nederveen Cappel, JHW de Wilt, J van der Wolde, FC den Boer, JWT Dekker, A Demirkiran, M Derkx-Hendriksen, FR Dijkstra, P van Duijvendijk, MS Dunker, QE Eijsbouts, H Fabry, F Ferenschild, JW Foppen, EJB Furnée, MF Gerhards, P Gerven, JAH Gooszen, JA Govaert, WMU Van Grevenstein, R Haen, JJ Harlaar, E Harst, K Havenga, J Heemskerk, JF Heeren, B Heijnen, P Heres, C Hoff, W Hogendoorn, P Hoogland, A Huijbers, JAH Gooszen, P Janssen, AC Jongen, EG Karthaus, A Keijzer, JMA Ketel, J Klaase, FWH Kloppenberg, ME Kool, R Kortekaas, PM Kruyt, JT Kuiper, B Lamme, JF Lange, T Lettinga, DJ Lips, F Logeman, MF Lutke Holzik, E Madsen, A Mamound, CC Marres, I Masselink, M Meerdink, AG Menon, JS Mieog, D Mierlo, GD Musters, PA Neijenhuis, J Nonner, M Oostdijk, SJ Oosterling, PMP Paul, KCMJC Peeters, ITA Pereboom, F Polat, P Poortman, M Raber, BMM Reiber, RJ Renger, CC van Rossem, HJ Rutten, A Rutten, R Schaapman, M Scheer, L Schoonderwoerd, N Schouten, AM Schreuder, WH Schreurs, GA Simkens, GD Slooter, HCE Sluijmer, N Smakman, R Smeenk, HS Snijders, DJA Sonneveld, B Spaansen, EJ Spillenaar Bilgen, E Steller, WH Steup, C Steur, E Stortelder, J Straatman, HA Swank, C Sietses, HA ten Berge, HG ten hoeve, WW ter Riele, IM Thorensen, B Tip-Pluijm, BR Toorenvliet, L Tseng, JB Tuynman, J van Bastelaar, SC van beek, AWH van de Ven, MAJ van de Weijer, C van den Berg, I van den Bosch, JDW van der Bilt, SJ van der Hagen, R van der hul, G van der Schelling, A van der Spek, N van der Wielen, E van duyn, C van Eekelen, JA van Essen, K van Gangelt, AAW van Geloven, C van kessel, YT van Loon, A van Rijswijk, SJ van Rooijen, T van Sprundel, L van Steensel, WF van Tets, HL van Westreenen, S Veltkamp, T Verhaak, PM Verheijen, L Versluis-Ossenwaarde, S Vijfhuize, WJ Vles, S Voeten, FJ Vogelaar, WW Vrijland, E Westerduin, ME Westerterp, M Wetzel,K Wevers, B Wiering, AC Witjes, MW Wouters, STK Yauw, EC Zeestraten, DD Zimmerman, and T Zwieten
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Jonker, F.H.W., Hagemans, J.A.W., Burger, J.W.A. et al. The influence of hospital volume on long-term oncological outcome after rectal cancer surgery. Int J Colorectal Dis 32, 1741–1747 (2017). https://doi.org/10.1007/s00384-017-2889-2
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DOI: https://doi.org/10.1007/s00384-017-2889-2