Skip to main content
SpringerLink
Log in

Colorectal surgery in Italy. Criteria to identify the hospital units and the tertiary referral centers entitled to perform it

  • Position Paper
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Improving the quality and effectiveness of care is a key priority of any health policy. The outcomes of health care can be considered as indicators of effectiveness or quality. The scientific literature that evaluates the association between the volume of activity and the outcome of health interventions has greatly developed over the past decade, but, for practical reasons, ethical and social issues, a few randomized controlled studies were made to evaluate this association, although there are numerous observational studies of outcome and systematic reviews of the studies themselves. The colorectal surgery is the most studied area and it represents the ideal testing ground to determine the effectiveness of the quality indicators because of the high incidence of the disease and the wide spread in the territory of the structures that aim to tackle these issues. Numerous studies have documented an association between the large number of colo-rectal surgical procedures and the quality of results. In particular, the volume of activity is one of the characteristics of measurable process that can have a significant impact on the outcome of health care. In conclusion, the ability to use volume thresholds as a proxy for quality is very tempting but it is only part of reality. Infact, the volume–outcome relationship strictly depends on the type of cancer (colon vs rectum) and it appears somehow stronger for the individual surgeon than for the hospital; especially for the 5-year overall survival, operative mortality and number of permanent stoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. I numeri del cancro in Italia (2014) AIOM. Intermedia Editore 2014

  2. Ponz De Leon M, Benatti P, Rossi G et al (2006) Epidemiology of tumors of the colon and rectum (ed). Ufficio Attività Grafiche, Modena

  3. Registro tumori.net (2015) SC Epidemiologia Analitica e Impatto Sanitario dell’Istituto Nazionale dei Tumori di Milano Reparto di Epidemiologia dei tumori—Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute—Istituto Superiore di Sanità (ISS)

  4. Leo E, Belli F, Miceli R, Mariani L, Gallino G, Battaglia L, Vannelli A, Andreola S (2009) Distal clearance margin of 1 cm or less: a safe distance in lower rectum cancer surgery. Int J Colorectal Dis 24(3):317–322

    Article  PubMed  Google Scholar 

  5. Revelli M, Paparo F, Bacigalupo L, Puppo C, Furnari M, Conforti C, Binda GA, Savarino E, Risso D, Rollandi GA (2016) Comparison of computed tomography and magnetic resonance imaging in the discrimination of intraperitoneal and extraperitoneal rectal cancer: initial experience. Clin Imaging 40(1):57–62

    Article  PubMed  Google Scholar 

  6. Touloumtzidis A, Sostmann B, Hilgers N, Renter MA, Kühn P, Goretzki PE, Lammers BJ (2014) Functional long-term results after rectal cancer surgery—technique of the athermal mesorectal excision. Int J Colorectal Dis 29(3):285–292

    Article  PubMed  Google Scholar 

  7. Emmertsen KJ, Laurberg S (2008) Bowel dysfunction after treatment for rectal cancer. Acta Oncol 47(6):994–1003. doi:10.1080/02841860802195251 (Review)

    Article  PubMed  Google Scholar 

  8. Bretagnol F, Troubat H, Laurent C, Zerbib F, Saric J, Rullier E (2004) Long-term functional results after sphincter-saving resection for rectal cancer. Gastroenterol Clin Biol 28(2):155–159

    Article  PubMed  Google Scholar 

  9. Almoudaris AM, Burns EM, Bottle A, Aylin P, Darzi A, Vincent C, Faiz O (2013) Single measures of performance do not reflect overall institutional quality in colorectal cancer surgery. Gut 62(3):423–429

    Article  PubMed  Google Scholar 

  10. 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 14:3

    Google Scholar 

  11. Costamagna D, Bobbio M, Pintor PP (2008) Il numero delle procedure chirurgiche come indicatore di qualità degli ospedali e dei chirurghi. Epidemiol Prev 32(1):61–64

  12. Amato L, Vecchi S, Davoli M, Minozzi S, Perucci CA (2009) Volume di attività ed esito delle cure degli interventi chirurgici per tumori: revisione sistematica della letteratura. Dipartimento di Epidemiologia del Servizio Sanitario Regione Lazio. Anno

  13. Burns EM, Bottle A, Almoudaris AM, Mamidanna R, Aylin P, Darzi A, Nicholls RJ, Faiz OD (2013) Hierarchical multilevel analysis of increased caseload volume and postoperative outcome after elective colorectal surgery. Br J Surg 100(11):1531–1538

    Article  CAS  PubMed  Google Scholar 

  14. Lenzi J, Lombardi R, Gori D, Zanini N, Tedesco D, Masetti M, Jovine E, Fantini MP (2013) Impact of procedure volumes and focused practice on short-term outcomes of elective and urgent colon cancer resection in Italy. PLoS One 8(5):1–7

  15. Programma Nazionale Esiti, Ministero della salute, Agenzia nazionale per i Servizi Sanitari Regionali. Edizione (2014)

  16. Harling H, Bulow S, Moller LN, Jorgensen T (2005) Hospital volume and outcome of rectal cancer surgery in Denmark 1994–1999. Colorectal Dis 7(1):90–95

    Article  CAS  PubMed  Google Scholar 

  17. Billingsley KG, Morris AM, Green P, Dominitz JA, Matthews B, Dobie SA et al (2008) Does surgeon case volume influence nonfatal adverse outcomes after rectal cancer resection? J Am Coll Surg 206(3):1167–1177

    Article  PubMed  PubMed Central  Google Scholar 

  18. Pucciarelli S, Chiappetta A, Giacomazzo G, Barina A, Gennaro N, Rebonato M, Nitti D, Saugo M (2016) Surgical Unit volume and 30-day reoperation rate following primary resection for colorectal cancer in the Veneto Region (Italy). Tech Coloproctol 20(1):31–40

    Article  CAS  PubMed  Google Scholar 

  19. Kressner M, Bohe M, Cedermark B, Dahlberg M, Damber L, Lindmark G, Ojerskog B, Sjödahl R, Johansson R, Påhlman L (2009) The impact of hospital volume on surgical outcome in patients with rectal cancer. Dis Colon Rectum 52(9):1542–1549

    Article  PubMed  Google Scholar 

  20. Harmon JW, Tang DG, Gordon TA et al (1999) Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. Ann Surg 230:404–411

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. McGory ML, Shekelle PG, Ko CY (2006) Development of quality indicators for patients undergoing colorectal cancer surgery. J Natl Cancer Inst 98(22):1623–1633

    Article  PubMed  Google Scholar 

  22. Royal College of Pathologists (2014) Standards and dataset for reporting cancers. Dataset for colorectal cancer histopathology report—July 2014

  23. College of American Pathologists (CAP) (2013) Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum—October 2013

  24. Foster JD, Jones EL, Falk S, Cooper EJ, Francis NK (2013) Timing of surgery after long-course neoadjuvant chemoradiotherapy for rectal cancer: a systematic review of the literature. Dis Colon Rectum 56(7):921–930 (Review)

    Article  PubMed  Google Scholar 

  25. Steenhagen E (2016) Enhanced recovery after surgery: it’s time to change practice!. Nutr Clin Pract 31(1):18–29

  26. Labgaa I, Jarrar G, Joliat GR, Allemann P, Gander S, Blanc C, Hübner M, Demartines N (2016) Implementation of enhanced recovery (ERAS) in colorectal surgery has a positive impact on non-ERAS liver surgery patients. World J Surg 40(5):1082–1091

  27. Dimick JB, Cowan JA, Upchurch GR Jr, Coletti LM (2003) Hospital volume and surgical outcomes for elderly patients with colorectal cancer in the United States. J Surg Res 83:68–78

    Google Scholar 

  28. Borowski DW, Kelly SB, Bradburn DM, Wilson RG, Gunn A, Ratcliffe AA (2007) Impact of surgeon volume and specialization on short-term outcomes in colorectal cancer surgery. Br J Surg 94(7):880–889

    Article  CAS  PubMed  Google Scholar 

  29. Gensini GF, Corcione F (2014) La chirurgia colorettale per via laparoscopica in Italia. Report sulla best practice. Burson-Marsteller. Dicembre

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Sacro Cuore Hospital, Via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy

    Giacomo Ruffo, Giuliano Barugola, Roberto Rossini & Carlo Augusto Sartori

Authors
  1. Giacomo Ruffo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giuliano Barugola
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roberto Rossini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carlo Augusto Sartori
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Giuliano Barugola or Roberto Rossini.

Ethics declarations

Conflict of interest

The Authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement of human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ruffo, G., Barugola, G., Rossini, R. et al. Colorectal surgery in Italy. Criteria to identify the hospital units and the tertiary referral centers entitled to perform it. Updates Surg 68, 123–128 (2016). https://doi.org/10.1007/s13304-016-0372-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-016-0372-1

Keywords

Search

Navigation