Association Between Hospital and Surgeon Volume and Rectal Cancer Surgery Outcomes in Patients With Rectal Cancer Treated Since 2000: Systematic Literature Review and Meta-analysis

Chioreso, Catherine; Vecchio, Natalie Del; Schweizer, Marin L.; Schlichting, Jennifer A.; Gribovskaja‐Rupp, Irena; Charlton, Mary E.

doi:10.1097/dcr.0000000000001198

Cited by 57 publications

(57 citation statements)

References 48 publications

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“…Finally, the difference may be related to the experience of the two highly specialized complex pelvic surgery centres in Australia compared with ten specialized colorectal centres in France, with only a few specialized in complex pelvic surgery. It has been shown that centralization of rectal cancer surgery improves outcomes [20][21][22] . This last argument is supported by the wide variation in R0 resection rates for LRRC from 46 to 68 per cent in French centres according to the number of patients treated.…”

Section: Discussionmentioning

confidence: 99%

International variation in managing locally advanced or recurrent rectal cancer: prospective benchmark analysis

Denost

Solomon

Tuech

et al. 2020

British Journal of Surgery

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Background: Tumour extension beyond the mesorectal plane (ymrT4) occurs in 5-10 per cent of patients with rectal cancer and 10 per cent of patients develop locally recurrent rectal cancer (LRRC) after primary surgery. There is global variation in healthcare delivery for these conditions. Methods: An international benchmark trial of the management of ymrT4 tumours and LRRC was undertaken in France and Australia between 2015 and 2017. Heterogeneity in management and operative decision-making were analysed by comparison of surgical resection rates, blinded intercountry reading of pelvic MRI, quality-of-life assessment and qualitative evaluations. Results: Among 154 patients (97 in France and 57 in Australia), 31⋅8 per cent had ymrT4 disease and 68⋅2 per cent LRRC. The surgical resection rates were 88 and 79 per cent in France and Australia respectively (P = 0⋅112). The concordance in operative planning was low (= 0⋅314); the rate of pelvic exenteration was lower in France than Australia both in clinical practice (36 of 78 versus 34 of 40; P < 0⋅001) and in theoretical conditions (10 of 25 versus 50 of 57; P = 0⋅002). The R0 resection rate was lower in France than Australia for LRRC (25 of 49 versus 18 of 21; P = 0⋅007) but not for ymrT4 tumours (21 of 26 versus 15 of 15; P = 0⋅139). Morbidity rates were similar. Patients who underwent non-exenterative procedures had higher scores on the mental functioning subscale at 12 months (P = 0⋅047), and a lower level of distress at 6 months (P = 0⋅049). Qualitative analysis highlighted five categories of psychosocial factors influencing treatment decisions: patient, strategy, specialist, organization and culture. Conclusion: This international benchmark trial has highlighted the differences in worldwide treatment of locally advanced and LRRC. Standardized care should improve outcomes for these patients.

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Section: Discussionmentioning

confidence: 99%

International variation in managing locally advanced or recurrent rectal cancer: prospective benchmark analysis

Denost

Solomon

Tuech

et al. 2020

British Journal of Surgery

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“…Furthermore, the definition of hospital volume was heterogeneous and the number of pooled patients was relatively low. A systematic review and meta‐analysis of 45 275 patients with rectal cancer treated within a multimodal setting showed reduced postoperative mortality for those treated in high‐volume hospitals.…”

Section: Introductionmentioning

confidence: 99%

Nationwide in-hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany

et al. 2020

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Background The impact of hospital volume after rectal cancer surgery is seldom investigated. This study aimed to analyse the impact of annual rectal cancer surgery cases per hospital on postoperative mortality and failure to rescue. Methods All patients diagnosed with rectal cancer and who had a rectal resection procedure code from 2012 to 2015 were identified from nationwide administrative hospital data. Hospitals were grouped into five quintiles according to caseload. The absolute number of patients, postoperative deaths and failure to rescue (defined as in‐hospital mortality after a documented postoperative complication) for severe postoperative complications were determined. Results Some 64 349 patients were identified. The overall in‐house mortality rate was 3·9 per cent. The crude in‐hospital mortality rate ranged from 5·3 per cent in very low‐volume hospitals to 2·6 per cent in very high‐volume centres, with a distinct trend between volume categories (P < 0·001). In multivariable logistic regression analysis using hospital volume as random effect, very high‐volume hospitals (53 interventions/year) had a risk‐adjusted odds ratio of 0·58 (95 per cent c.i. 0·47 to 0·73), compared with the baseline in‐house mortality rate in very low‐volume hospitals (6 interventions per year) (P < 0·001). The overall postoperative complication rate was comparable between different volume quintiles, but failure to rescue decreased significantly with increasing caseload (15·6 per cent after pulmonary embolism in the highest volume quintile versus 38 per cent in the lowest quintile; P = 0·010). Conclusion Patients who had rectal cancer surgery in high‐volume hospitals showed better outcomes and reduced failure to rescue rates for severe complications than those treated in low‐volume hospitals.

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“…However, the effect sizes are small, it is a non-linear effect and the definition of high hospital volume is heterogenic between different studies. This makes it hard to define a clear threshold for minimum annual number of colorectal cancer surgeries per hospital 20–24. Also, a difference between US and non-US data suggests that hospital level variability was less of a problem outside the USA than in the USA 20 24.…”

Section: Discussionmentioning

confidence: 99%

Surgeon perceived most important factors to achieve the best hospital performance on colorectal cancer surgery: a Dutch modified Delphi method

et al. 2019

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ObjectivesHospital variation in risk-adjusted outcomes after colorectal cancer surgery has been shown. However, explanatory factors are not sufficiently clear. The objective of this study was to identify factors perceived by gastrointestinal surgeons as important to achieve excellent casemix-adjusted outcomes after colorectal cancer surgery.DesignBased on literature and experts’ opinion, 86 factors associated with serious complications, failure to rescue and mortality were listed. These were presented to gastrointestinal surgeons through two web-based surveys and an expert meeting. Participants were asked to choose their top 10 of most important factors.ParticipantsDutch gastrointestinal surgeons (n=52) of different hospitals and different hospital types (general/teaching/academic).ResultsOf 31 invited experts for the first survey and meeting, 71% responded. Of 130 invited surgeons, 34 responded to the second survey. Factors deemed important were: procedural hospital volume (46% in top 10), specialised surgeons performing surgery, (elective 87%, emergency 60% and reoperations 62% in top 10), accessibility of, and daily ward rounds by specialised surgeons (41% and 38% in top 10), preoperative screening for malnutrition (57% in top 10), a protocol for recognition of anastomotic leakage and rapid reintervention (54% and 49% in top 10).ConclusionProcedural hospital volume, specialisation of surgeons, screening for malnutrition, early recognition of complications followed by rapid action were perceived as most important factors to achieve good outcomes by gastrointestinal surgeons.

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Association Between Hospital and Surgeon Volume and Rectal Cancer Surgery Outcomes in Patients With Rectal Cancer Treated Since 2000: Systematic Literature Review and Meta-analysis

Cited by 57 publications

References 48 publications

International variation in managing locally advanced or recurrent rectal cancer: prospective benchmark analysis

International variation in managing locally advanced or recurrent rectal cancer: prospective benchmark analysis

Nationwide in-hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany

Surgeon perceived most important factors to achieve the best hospital performance on colorectal cancer surgery: a Dutch modified Delphi method

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