Abstract
Introduction
The policy of redistributing surgical case volume toward designated high-volume hospitals to improve outcome in cancer is supported by an international literature on volume–outcome association.
Methods
All patients who underwent surgery for colorectal carcinoma under the care of one surgeon at a non-high-volume hospital 1995–2005 were identified. 5-year overall survival probability and 30-day operative mortality were measured.
Results
Two hundred and forty patients were identified. Mean annual surgeon caseload was 21.6 (SD 4.2). 5-year overall survival probability was 57.1% (95% confidence interval ±7.4%). 30-day operative mortality was 4.6%.
Conclusion
Estimates of outcome were not different from publically available values from a high-volume unit in Ireland. These findings suggest that concentrating case volume per se may not improve outcome to the extent desired. Future improvement in colorectal cancer outcome is just as likely to derive from wider screening, better surgical training, and adequately powered clinical research, should these accompany centralisation.
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References
Luft HS, Bunker JP, Enthoven AC (1979) Should operations be regionalized? The empirical relation between surgical volume and mortality. NEJM 301:1364–1369
Dudley RA, Johansen KL, Brand R et al (2000) Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 283:1159–1166
Birkmeyer JD, Siewers AE, Finlayson EVA et al (2002) Hospital volume and surgical mortality in the United States. NEJM 346:1128–1137
Comber H, Walsh PM (2008) Patterns of care and survival of cancer patients in Ireland 1994 to 2004. Summary report, NCRI
Comber H, Walsh PM (2006) Patterns of care and survival of cancer patients in Ireland 1994 to 2001, Chap 4. Colorectal cancer, NCRI
Reynolds JV, Rowley S, Stuart C et al (2007) Six-year cancer audit report, St. James’s Hospital 2001–2006. Cancer Audit Programme Team, St. James’s Hospital
Kaplan E, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:257–481
Schrag D, Cramer D, Bach PB et al (2000) Influence of hospital procedure volume on outcomes following surgery for colon cancer. JAMA 284(23):3028–3035
Shahian DM, Normand ST (2003) The volume–outcome relationship: from Luft to leapfrog. Ann Thorac Surg 75:1048–1058
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Markey, G.C., Wosu, E. & Keane, R. Outside the high-volume unit: survival in an 11-year cohort of colorectal cancer patients. Ir J Med Sci 180, 97–101 (2011). https://doi.org/10.1007/s11845-010-0561-8
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DOI: https://doi.org/10.1007/s11845-010-0561-8