Skip to main content

Advertisement

SpringerLink
Log in

Prognostic impact of hospital volume on familial adenomatous polyposis: a nationwide multicenter study

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Many studies have shown that hospital volume is significantly associated with short- and long-term outcomes in various diseases, including cancer. However, there have been no reports discussing the relationship between hospital volume and familial adenomatous polyposis (FAP). This study aimed to clarify whether hospital volume affects short- and long-term outcomes in FAP patients.

Methods

We established a retrospectively collected database of FAP patients who underwent initial surgical treatment at 23 Japanese institutions during 2000–2012. Factors associated with short- and long-term outcomes were analyzed.

Results

The study cohort included 303 FAP patients. These patients were classified into tertile categories according to hospital volume: low (n = 31), middle (n = 72), and high volume (n = 200). The proportion of only adenoma/stage 0 was comparable among tertile categories. The adoption of operative procedure significantly differed among tertile categories; specifically, high-volume institutions preferred handsewn ileal pouch-anal anastomosis without diverting ileostomy (P < 0.001 and < 0.001, respectively). Nevertheless, the frequency of complications with Clavien-Dindo classification grade ≥ 3 was not significantly different among tertile categories. Functional results were acceptable in every category. Wexner scores were significantly lower in high-volume compared to low-volume institutions (P = 0.02). Multivariate analyses showed that UICC stage and hospital volume were significantly associated with overall survival (P = 0.04 and 0.03, respectively).

Conclusions

Hospital volume was significantly associated with short- and long-term outcomes in FAP patients.

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

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cunningham D, Atkin W, Lenz H-J, Lynch HT, Minsky B, Nordlinger B, Starling N (2010) Colorectal cancer. Lancet 375(9719):1030–1047. doi:10.1016/s0140-6736(10)60353-4

    Article  PubMed  Google Scholar 

  2. Bülow S, Nielsen TF, Bülow C, Bisgaard ML, Karlsen L, Moesgaard F (1996) The incidence rate of familial adenomatous polyposis. Int J Color Dis 11(2):88–91. doi:10.1007/bf00342466

    Article  Google Scholar 

  3. Campos FG (2014) Surgical treatment of familial adenomatous polyposis: dilemmas and current recommendations. World J Gastroenterol 20(44):16620–16629. doi:10.3748/wjg.v20.i44.16620

    Article  PubMed Central  PubMed  Google Scholar 

  4. Nishisho I, Nakamura Y, Miyoshi Y, Miki Y, Ando H, Horii A, Koyama K, Utsunomiya J, Baba S, Hedge P, Markham A, Krush AJ, Petersen G, Hamilton SR, Nilbert MC, Levy DB, Bryan TM, Preisinger AC, Smith KJ, Su L-K, Kinzler KW, Vogelstein B (1991) Mutations of chromosome 5q21 genes in FAP and colorectal cancer patients. Science 253(5020):665–669

    Article  CAS  PubMed  Google Scholar 

  5. Groden J, Thliveris A, Samowitz W, Carlson M, Gelbert L, Albertsen H, Joslyn G, Stevens J, Spirio L, Robertson M, Sargeant L, Krapcho K, Wolff E, Burt R, Hughes JP, Warrington J, McPherson J, Wasmuth J, Le Paslier D, Abderrahim H, Cohen D, Leppert M, White R (1991) Identification and characterization of the familial adenomatous polyposis coli gene. Cell 66(3):589–600. doi:10.1016/0092-8674(81)90021-0

    Article  CAS  PubMed  Google Scholar 

  6. Vasen HFA, Möslein G, Alonso A, Aretz S, Bernstein I, Bertario L, Blanco I, Bülow S, Burn J, Capella G, Colas C, Engel C, Frayling I, Friedl W, Hes FJ, Hodgson S, Järvinen H, Mecklin J-P, Møller P, Myrhøi T, Nagengast FM, Parc Y, Phillips R, Clark SK, de Leon MP, Renkonen-Sinisalo L, Sampson JR, Stormorken A, Tejpar S, Thomas HJW, Wijnen J (2008) Guidelines for the clinical management of familial adenomatous polyposis (FAP). Gut 57(5):704–713. doi:10.1136/gut.2007.136127

    Article  CAS  PubMed  Google Scholar 

  7. Hueting WE, Buskens E, van der Tweel I, Gooszen HG, van Laarhoven CJ (2005) Results and complications after ileal pouch anal anastomosis: a meta-analysis of 43 observational studies comprising 9,317 patients. Dig Surg 22(1–2):69–79. doi:10.1159/000085356

    Article  PubMed  Google Scholar 

  8. Aziz O, Athanasiou T, Fazio VW, Nicholls RJ, Darzi AW, Church J, Phillips RK, Tekkis PP (2006) Meta-analysis of observational studies of ileorectal versus ileal pouch-anal anastomosis for familial adenomatous polyposis. Br J Surg 93(4):407–417. doi:10.1002/bjs.5276

    Article  CAS  PubMed  Google Scholar 

  9. Birkmeyer JD, Siewers AE, Finlayson EVA, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346(15):1128–1137. doi:10.1056/NEJMsa012337

    Article  PubMed  Google Scholar 

  10. Tol JA, van Gulik TM, Busch OR, Gouma DJ (2012) Centralization of highly complex low-volume procedures in upper gastrointestinal surgery. A summary of systematic reviews and meta-analyses. Dig Surg 29(5):374–383. doi:10.1159/000343929

    Article  PubMed  Google Scholar 

  11. Birkmeyer JD, Sun Y, Wong SL, Stukel TA (2007) Hospital volume and late survival after cancer surgery. Ann Surg 245(5):777–783. doi:10.1097/01.sla.0000252402.33814.dd

    Article  PubMed Central  PubMed  Google Scholar 

  12. Fong Y, Gonen M, Rubin D, Radzyner M, Brennan MF (2005) Long-term survival is superior after resection for cancer in high-volume centers. Ann Surg 242(4):540–544 discussion 544-547

    PubMed Central  PubMed  Google Scholar 

  13. van Gijn W, Gooiker GA, Wouters MWJM, Post PN, Tollenaar RAEM, van de Velde CJH (2010) Volume and outcome in colorectal cancer surgery. European Journal of Surgical Oncology (EJSO) 36(supplement 1):S55–S63. doi:10.1016/j.Ejso.2010.06.027

    Article  Google Scholar 

  14. Khani MH, Smedh K (2010) Centralization of rectal cancer surgery improves long-term survival. Color Dis 12(9):874–879. doi:10.1111/j.1463-1318.2009.02098.x

    Article  Google Scholar 

  15. Schrag D, Panageas KS, Riedel E, Cramer LD, Guillem JG, Bach PB, Begg CB (2002) Hospital and surgeon procedure volume as predictors of outcome following rectal cancer resection. Ann Surg 236(5):583–592. doi:10.1097/01.SLA.0000033036.14533.BC

    Article  PubMed Central  PubMed  Google Scholar 

  16. Yamaguchi T, Ishida H, Ueno H, Kobayashi H, Hinoi T, Inoue Y, Ishida F, Kanemitsu Y, Konishi T, Tomita N, Matsubara N, Watanabe T, Sugihara K (2016) Upper gastrointestinal tumours in Japanese familial adenomatous polyposis patients. Jpn J Clin Oncol 46(4):310–315. doi:10.1093/jjco/hyv210

    Article  PubMed Central  PubMed  Google Scholar 

  17. American Society of Anesthesiologists (2014) ASA Physical Classification System. http://www.asahq.org/~/media/modules/digital briefcase apps/asa practice management/standards guidelines statements/administration/asa-physical-status-classification-system.pdf. Accessed 10 January 2017

  18. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed Central  PubMed  Google Scholar 

  19. Luft HS, Bunker JP, Enthoven AC (1979) Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 301(25):1364–1369. doi:10.1056/nejm197912203012503

    Article  CAS  PubMed  Google Scholar 

  20. Kulkarni GS, Urbach DR, Austin PC, Fleshner NE, Laupacis A (2013) Higher surgeon and hospital volume improves long-term survival after radical cystectomy. Cancer 119(19):3546–3554. doi:10.1002/cncr.28235

    Article  PubMed  Google Scholar 

  21. Aquina CT, Probst CP, Becerra AZ, Iannuzzi JC, Kelly KN, Hensley BJ, Rickles AS, Noyes K, Fleming FJ, Monson JR (2016) High volume improves outcomes: the argument for centralization of rectal cancer surgery. Surgery 159(3):736–748. doi:10.1016/j.surg.2015.09.021

    Article  PubMed  Google Scholar 

  22. Mokdad AA, Zhu H, Marrero JA, Mansour JC, Singal AG, Yopp AC (2016) Hospital volume and survival after hepatocellular carcinoma diagnosis. Am J Gastroenterol 111(7):967–975. doi:10.1038/ajg.2016.181

    Article  PubMed  Google Scholar 

  23. Hodgson DC, Zhang W, Zaslavsky AM, Fuchs CS, Wright WE, Ayanian JZ (2003) Relation of hospital volume to colostomy rates and survival for patients with rectal cancer. J Natl Cancer Inst 95(10):708–716. doi:10.1093/jnci/95.10.708

    Article  PubMed  Google Scholar 

  24. Kumpulainen S, Grenman S, Kyyronen P, Pukkala E, Sankila R (2002) Evidence of benefit from centralised treatment of ovarian cancer: a nationwide population-based survival analysis in Finland. Int J Cancer 102(5):541–544. doi:10.1002/ijc.10754

    Article  CAS  PubMed  Google Scholar 

  25. Delitto D, Black BS, Cunningham HB, Sliesoraitis S, Lu X, Liu C, Sarosi GA, Thomas RM, Trevino JG, Hughes SJ, George TJ Jr, Behrns KE (2016) Standardization of surgical care in a high-volume center improves survival in resected pancreatic head cancer. Am J Surg. doi:10.1016/j.amjsurg.2016.03.001

  26. Coupland VH, Lagergren J, Luchtenborg M, Jack RH, Allum W, Holmberg L, Hanna GB, Pearce N, Moller H (2013) Hospital volume, proportion resected and mortality from oesophageal and gastric cancer: a population-based study in England, 2004-2008. Gut 62(7):961–966. doi:10.1136/gutjnl-2012-303008

    Article  PubMed  Google Scholar 

  27. Luft HS, Hunt SS, Maerki SC (1987) The volume-outcome relationship: practice-makes-perfect or selective-referral patterns? Health Serv Res 22(2):157–182

    CAS  PubMed Central  PubMed  Google Scholar 

  28. Arvanitis ML, Jagelman DG, Fazio VW, Lavery IC, McGannon E (1990) Mortality in patients with familial adenomatous polyposis. Dis Colon Rectum 33(8):639–642. doi:10.1007/bf02150736

    Article  CAS  PubMed  Google Scholar 

  29. Groen EJ, Roos A, Muntinghe FL, Enting RH, de Vries J, Kleibeuker JH, Witjes MJ, Links TP, van Beek AP (2008) Extra-intestinal manifestations of familial adenomatous polyposis. Ann Surg Oncol 15(9):2439–2450. doi:10.1245/s10434-008-9981-3

    Article  PubMed Central  PubMed  Google Scholar 

  30. Garbay D, Le Cesne A, Penel N, Chevreau C, Marec-Berard P, Blay JY, Debled M, Isambert N, Thyss A, Bompas E, Collard O, Salas S, Coindre JM, Bui B, Italiano A (2012) Chemotherapy in patients with desmoid tumors: a study from the French Sarcoma Group (FSG). Ann Oncol 23(1):182–186. doi:10.1093/annonc/mdr051

    Article  CAS  PubMed  Google Scholar 

  31. Bülow S (2003) Results of national registration of familial adenomatous polyposis. Gut 52(5):742–746. doi:10.1136/gut.52.5.742

    Article  PubMed Central  PubMed  Google Scholar 

  32. Koskenvuo L, Pitkaniemi J, Rantanen M, Lepisto A (2016) Impact of screening on survival in familial adenomatous polyposis. J Clin Gastroenterol 50(1):40–44. doi:10.1097/mcg.0000000000000426

    Article  PubMed  Google Scholar 

  33. von Roon AC, Will OC, Man RF, Neale KF, Phillips RK, Nicholls RJ, Clark SK, Tekkis PP (2011) Mucosectomy with handsewn anastomosis reduces the risk of adenoma formation in the anorectal segment after restorative proctocolectomy for familial adenomatous polyposis. Ann Surg 253(2):314–317. doi:10.1097/SLA.0b013e318f3f498

    Article  Google Scholar 

  34. Tekkis PP, Fazio VW, Lavery IC, Remzi FH, Senagore AJ, Wu JS, Strong SA, Poloneicki JD, Hull TL, Church JM (2005) Evaluation of the learning curve in ileal pouch-anal anastomosis surgery. Ann Surg 241(2):262–268

    Article  PubMed Central  PubMed  Google Scholar 

  35. Lovegrove RE, Constantinides VA, Heriot AG, Athanasiou T, Darzi A, Remzi FH, Nicholls RJ, Fazio VW, Tekkis PP (2006) A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients. Ann Surg 244(1):18–26. doi:10.1097/01.sla.0000225031.15405.a3

    Article  PubMed Central  PubMed  Google Scholar 

  36. Becker JM, McGrath KM, Meagher MP, Parodi JE, Dunnegan DA, Soper NJ (1991) Late functional adaptation after colectomy, mucosal proctectomy, and ileal pouch-anal anastomosis. Surgery 110(4):718–724 discussion 725

    CAS  PubMed  Google Scholar 

  37. Fazio VW, Ziv Y, Church JM, Oakley JR, Lavery IC, Milsom JW, Schroeder TK (1995) Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 222 (2):120–127

  38. Sugerman HJ, Sugerman EL, Meador JG, Newsome HH Jr, Kellum JM Jr, DeMaria EJ (2000) Ileal pouch anal anastomosis without ileal diversion. Ann Surg 232(4):530–541

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Hor T, Zalinski S, Lefevre JH, Shields C, Attal E, Tiret E, Parc Y (2012) Feasibility of laparoscopic restorative proctocolectomy without diverting stoma. Dig Liver Dis 44(2):118–122. doi:10.1016/j.dld.2011.09.007

    Article  PubMed  Google Scholar 

  40. Nugent KP, Spigelman AD, Phillips RK (1993) Life expectancy after colectomy and ileorectal anastomosis for familial adenomatous polyposis. Dis Colon Rectum 36(11):1059–1062

    Article  CAS  PubMed  Google Scholar 

  41. Belchetz LA, Berk T, Bapat BV, Cohen Z, Gallinger S (1996) Changing causes of mortality in patients with familial adenomatous polyposis. Dis Colon Rectum 39(4):384–387

    Article  CAS  PubMed  Google Scholar 

  42. Iwama T, Tamura K, Morita T, Hirai T, Hasegawa H, Koizumi K, Shirouzu K, Sugihara K, Yamamura T, Muto T, Utsunomiya J, Japanese Society for Cancer of the C, Rectum (2004) A clinical overview of familial adenomatous polyposis derived from the database of the Polyposis Registry of Japan. Int J Clin Oncol 9(4):308–316. doi:10.1007/s10147-004-0414-4

    Article  PubMed  Google Scholar 

  43. Latchford AR, Neale KF, Spigelman AD, Phillips RK, Clark SK (2009) Features of duodenal cancer in patients with familial adenomatous polyposis. Clin Gastroenterol Hepatol 7(6):659–663. doi:10.1016/j.cgh.2009.02.028

    Article  PubMed  Google Scholar 

  44. Bulow S, Christensen IJ, Hojen H, Bjork J, Elmberg M, Jarvinen H, Lepisto A, Nieuwenhuis M, Vasen H (2012) Duodenal surveillance improves the prognosis after duodenal cancer in familial adenomatous polyposis. Color Dis 14(8):947–952. doi:10.1111/j.1463-1318.2011.02844.x

    Article  CAS  Google Scholar 

  45. Moriya Y, Sugihara K, Akasu T, Fujita S (1997) Importance of extended lymphadenectomy with lateral node dissection for advanced lower rectal cancer. World J Surg 21(7):728–732

    Article  CAS  PubMed  Google Scholar 

  46. Kusters M, Beets GL, van de Velde CJ, Beets-Tan RG, Marijnen CA, Rutten HJ, Putter H, Moriya Y (2009) A comparison between the treatment of low rectal cancer in Japan and the Netherlands, focusing on the patterns of local recurrence. Ann Surg 249(2):229–235. doi:10.1097/SLA.0b013e318190a664

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the following investigators’ valuable assistance with collecting data on FAP patients: Hirotoshi Hasegawa, Department of Surgery, Keio University School of Medicine, Tokyo; Kazuhiko Yoshimatsu, Department of Surgery, Tokyo Women’s Medical University Medical Center East, Tokyo; Kenjiro Kotake, Department of Surgery, Tochigi Cancer Center, Tochigi; Kensuke Kumamoto, Department of Organ Regulatory Surgery, Fukushima Medical University School of Medicine, Fukushima; Kiyotaka Kurachi, Department of Surgery 2, Hamamatsu University School of Medicine, Shizuoka; Koji Komori, Department of Gastroenterological Surgery Aichi Cancer Center Hospital, Aichi; Kohji Tanakaya, Department of Surgery, Iwakuni Clinical Center, Yamaguchi; Masataka Ikeda, Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka; Motoi Koyama, Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori; Nagahide Matsubara, Department of Surgery, Hyogo College of Medicine, Hyogo; Takeshi Nagasaka, Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Toshiaki Watanabe, Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo; Toshimasa Yatsuoka, Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama; and Yoshito Akagi, Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka.

Author information

Authors and Affiliations

  1. Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Masahiro Tanaka & Yukihide Kanemitsu

  2. Department of Surgery, National Defense Medical College, Saitama, Japan

    Hideki Ueno

  3. Department of Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan

    Hirotoshi Kobayashi

  4. Gastroenterological Center, Department of Gastroenterological Surgery, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan

    Tsuyoshi Konishi

  5. Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan

    Fumio Ishida

  6. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

    Tatsuro Yamaguchi

  7. Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Takao Hinoi

  8. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan

    Yasuhiro Inoue

  9. Department of Surgery, Hyogo College of Medicine, Hyogo, Japan

    Naohiro Tomita

  10. Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan

    Hideyuki Ishida

  11. Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara

Authors
  1. Masahiro Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yukihide Kanemitsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hideki Ueno
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hirotoshi Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tsuyoshi Konishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fumio Ishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tatsuro Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takao Hinoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yasuhiro Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Naohiro Tomita
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hideyuki Ishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kenichi Sugihara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yukihide Kanemitsu.

Ethics declarations

Funding

This study was supported in part by a grant-in-aid for cancer research from the Ministry of Health, Labor and Welfare, and by the Japanese Society for Cancer of the Colon and Rectum.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was not obtained from all individual participants included in the study.

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. 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

Tanaka, M., Kanemitsu, Y., Ueno, H. et al. Prognostic impact of hospital volume on familial adenomatous polyposis: a nationwide multicenter study. Int J Colorectal Dis 32, 1489–1498 (2017). https://doi.org/10.1007/s00384-017-2885-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-017-2885-6

Keywords

Search

Navigation