Hospital variance in neoadjuvant rectal cancer treatment and the influence of a national guideline update: Results of a nationwide population-based study

Köeter, Tijmen; Elferink, M.A.G.; Verhoeven, Rob H.A.; Zimmerman, D. D. E.; Wasowicz, Dareczka K.; Verheij, Marcel; Wilt, Johannes H. W. de

doi:10.1016/j.radonc.2019.12.020

Cited by 9 publications

(6 citation statements)

References 43 publications

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“…As a result, the guideline was revised in 2014 recommending a more restrictive use of radiotherapy. This probably explains the clear decrease in the use of neoadjuvant radiotherapy after 2014 and is in line with a previous report [32].…”

Section: Discussionsupporting

confidence: 92%

Changes in rectal cancer treatment after the introduction of a national screening program; Increasing use of less invasive strategies within a national cohort

Giesen

Olthof

Elferink

et al. 2022

European Journal of Surgical Oncology

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Section: Discussionsupporting

confidence: 92%

Changes in rectal cancer treatment after the introduction of a national screening program; Increasing use of less invasive strategies within a national cohort

Giesen

Olthof

Elferink

et al. 2022

European Journal of Surgical Oncology

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“…As a result, deciding whether or not to operate leaves more room for discussion in MDT meetings. Furthermore a wide variation of neoadjuvant therapy for rectal cancer between hospitals still seems to exist despite recent national guidelines [13]. We therefore hypothesize that the inter-hospital variation for rectal cancer surgery in the Netherlands is substantial.…”

Section: Introductionmentioning

confidence: 94%

Surgery for rectal cancer: Differences in resection rates among hospitals in the Netherlands

Giesen

Olthof

Elferink

et al. 2021

European Journal of Surgical Oncology

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Aim: Numerous quality improvement initiatives for rectal cancer surgery have focused on textbook outcome parameters. In these studies, resection rate and patients who did not undergo surgery are not included, but these parameters might help to evaluate the surgical care for rectal cancer. The aim of this study is to assess the variation of non-metastatic rectal cancer resection rates among hospitals and its effect on patient outcomes. Methods: All patients diagnosed with non-metastatic rectal cancer between 2013 and 2018 were selected from the Netherlands Cancer Registry. Hospitals were categorized in quartiles according to resection rates. A multivariable logistic analysis was performed to determine variation in resection rate between these quartiles using a logistic regression analysis to correct for confounders. The association between resection rates and survival was analyzed using Kaplan-Meier method and Cox-regression analysis. Results: A total of 22,530 patients were included in the analysis. Resection rates varied from 68 to 89% between hospitals. After multivariable analysis, resection rate remained significantly different among the quartiles when correcting for several factors (odds ratio (95%Confidence-interval) 1.71 (1.56e1.88), 2.42 (2.19e2.67), and 4.04 (3.61e4.53) for increasing resection rate quartiles, in reference to the lowest quartile). A higher resection rate was associated with better overall survival, in multivariable analysis this survival benefit could no longer be identified. Conclusion:There is a substantial variation in resection rates for rectal cancer among hospitals in the Netherlands with an impact on overall survival. This may be a relevant issue when analyzing the overall quality of rectal cancer care.

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“…The lowest volume category was based on the Dutch minimum annual volume norm for rectal cancer. The same cut-offs were used as previously reported 11 . Multivariable logistic regression models were used to determine the association between hospital volume and the presence of AL, positive CRM and 30-day and 90-day mortality rates adjusted for gender, age, year of surgical resection, cT stage, cN stage, differentiation grade, tumour height and neoadjuvant treatment.…”

Section: Methodsmentioning

confidence: 99%

“…Previous nationwide population-based studies have reported the effect of hospital variation on the probability of patients receiving a curative treatment for colon, gastric, pancreatic and oesophageal cancer 7–10 . Recently, a significant hospital variation regarding neoadjuvant treatment in rectal cancer has been described 11 . Furthermore, differences in postoperative outcome due to variability based on hospital type and volume were reported in pancreatic and upper gastrointestinal cancer surgery 12–15 .…”

Section: Introductionmentioning

confidence: 99%

Hospital variation in sphincter-preservation rates in rectal cancer treatment: results of a population-based study in the Netherlands

et al. 2021

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Background This study aimed to examine the sphincter-preservation rate variations in rectal cancer surgery. The influence of hospital volume on sphincter-preservation rates and short-term outcomes (anastomotic leakage (AL), positive circumferential resection margin (CRM), 30- and 90-day mortality rates) were also analysed. Methods Non-metastasized rectal cancer patients treated between 2009 and 2016 were selected from the Netherlands Cancer Registry. Surgical procedures were divided into sphincter-preserving surgery and an end colostomy group. Multivariable logistic regression models were generated to estimate the probability of undergoing sphincter-preserving surgery according to the hospital of surgery and tumour height (low, 5 cm or less, mid, more than 5 cm to 10 cm, and high, more than 10 cm). The influence of annual hospital volume (less than 20, 20–39, more than 40 resections) on sphincter-preservation rate and short-term outcomes was also examined. Results A total of 20 959 patients were included (11 611 sphincter preservation and 8079 end colostomy) and the observed median sphincter-preservation rate in low, mid and high rectal cancer was 29.3, 75.6 and 87.9 per cent respectively. After case-mix adjustment, hospital of surgery was a significant factor for patients’ likelihood for sphincter preservation in all three subgroups (P < 0.001). In mid rectal cancer, borderline higher rates of sphincter preservation were associated with low-volume hospitals (odds ratio 1.20, 95 per cent c.i. 1.01 to 1.43). No significant association between annual hospital volume and sphincter-preservation rate in low and high rectal cancer nor short-term outcomes (AL, positive CRM rate and 30- and 90-day mortality rates) was identified. Conclusion This population-based study showed a significant hospital variation in sphincter-preservation rates in rectal surgery. The annual hospital volume, however, was not associated with sphincter-preservation rates in low, and high rectal cancer nor with other short-term outcomes.

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Hospital variance in neoadjuvant rectal cancer treatment and the influence of a national guideline update: Results of a nationwide population-based study

Cited by 9 publications

References 43 publications

Changes in rectal cancer treatment after the introduction of a national screening program; Increasing use of less invasive strategies within a national cohort

Changes in rectal cancer treatment after the introduction of a national screening program; Increasing use of less invasive strategies within a national cohort

Surgery for rectal cancer: Differences in resection rates among hospitals in the Netherlands

Hospital variation in sphincter-preservation rates in rectal cancer treatment: results of a population-based study in the Netherlands

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