The impact of hospital volume on perioperative outcomes of rectal cancer

Publication date: Available online 29 July 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Frederik HW. Jonker, Jan Hagemans, Cornelis Verhoef, Pim Burger
BackgroundThe purpose of this study was to investigate the impact of hospital volume on perioperative outcomes of clinical tumour stage (cT)1-3 and cT4 rectal cancer.Methods16.162 patients operated for rectal cancer enrolled in the Dutch Surgical Colorectal Audit between 2009 and 2015 were included. Hospitals were divided into low (<20 cases/year), medium (21-50 cases/year) and high (>50 cases/year) volume for cT1-3 rectal cancer, and for cT4 rectal cancer into low (1-4 cases/year), medium (5-9 cases/year) and high (≥10 cases/year) volume. The influence of hospital volume on perioperative outcomes was investigated.ResultsWith regards to cT1-3 tumours, low volume hospitals were associated with lower risk of complications (33.8% vs. 36.6% and 38.1%, p=0.009), anastomotic leakage (5.4% vs. 8.1% and 8.6%), and reinterventions (11.5% vs. 12.6% and 14.8%, p=0.002) as compared to medium and high volume hospitals. Thirty-day mortality and R0 rates were comparable between groups.In high cT4 volume hospitals, rates of extensive resection of cT4 tumour involvement (49.4% vs. 25.4% and 15.5%, p<0.001) and additional resection of metastasis (17.5% vs. 14.4% and 3.0%, p<0.001) were increased as compared to medium and low volume hospitals. Thirty-day mortality and R0 rates were comparable between groups. In a sub-analysis of pathologic tumour stage 4 patients, irradical resections were increased in low volume hospitals (33.8% vs. 22.5% and 20.8% in medium and high volume hospitals, p=0.031).ConclusionsFor true cT4 rectal cancer, high volume hospitals may offer a better multimodality treatment, while for cT1-3 rectal cancer there appears no benefit for centralization.



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