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

Giesen, Louis J. X.; Olthof, Pim B.; Elferink, M.A.G.; Verhoef, Cornelis; Dekker, Jan Willem T.

doi:10.1016/j.ejso.2021.04.030

Cited by 8 publications

(7 citation statements)

References 27 publications

(25 reference statements)

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“…The study was based on a retrospective real-world study; we inevitably encounter the problem of controlling confounding factors. The present study suggested the distribution of the age, differentiated grade, T stage, N stage, M stage, and metastatic organ number showed marked differences between the patients with and without surgery, which was consistent with the previous studies [15,16]. Many methods such as multivariable Cox regression and instrumental variable method were recommended to adjust the effect of these confounding factors.…”

Section: Discussionsupporting

confidence: 91%

Not all rectal cancer patients could benefit from the surgery on the primary site

Zhou

Xia

et al. 2022

Preprint

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Purpose Pieces of evidence showed the surgery on the primary site could improve the prognosis of rectal cancer patients, but the results were inconsistent. The present study investigates whether all patients could benefit from the surgery. Methods The rectal cancer patients diagnosed between 2010 and 2019 in the Surveillance, Epidemiology, and End Results cohort were included. Multivariable Cox regression was utilized to investigate the effect of the primary site surgery on the prognosis in total patients and stratified by the age, M stage and the number of distant metastatic organs. The propensity score matching (PSM) method was also used to balance observed covariates and Kaplan-Meier method with the log-rank test was used to exam the differences in the prognosis. Results A total of 76,941 rectal cancer patients were included and about 68.1% received surgery. The patients with surgery have a relatively lower proportion of advanced age, higher differentiated grade, T stage, N stage, M stage, and bone, brain, lung, and liver metastasis than patients without surgery. Multivariable Cox regression showed a protective effect of the surgery on the prognosis, even in patients with advanced age, distant metastasis, and multiple organ metastasis. However, no association was found in patients with four organ metastases. The PSM also confirmed the results mentioned above. Conclusion Not all rectal cancer patients could benefit from the surgery, especially the patients with four organ distant metastases. The results could help the clinicians to tailor targeted treatment regimens and provide a guideline for making surgical decisions.

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Section: Discussionsupporting

confidence: 91%

Not all rectal cancer patients could benefit from the surgery on the primary site

Zhou

Xia

et al. 2022

Preprint

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“…Those authors who did report providing feedback fed the results into quality improvement efforts at the regional (9; 39%) or national (6; 27%) level, sent the results to all studied groups (4; 18%), or both sent the results to all studied groups and fed the results into quality improvement efforts (3; 13%). Notably, only one of the 22 studies advocated for public reporting of their outcomes 39 . The feedback of all other studies was explicitly for the use of healthcare systems.…”

Section: Resultsmentioning

confidence: 99%

“…Interestingly, only 22 studies (25%) reported notifying those providing the data of the variation they detected or otherwise using the results to inform quality improvement efforts. Only one study advocated for public reporting of their findings 39 . The majority of these quality indicators were derived from high-income settings.…”

Section: Discussionmentioning

confidence: 99%

“…Acknowledging the expectation that many studies would be exploratory, perhaps the most notable result of this analysis is that only 22 (25%) of the included studies reported feeding the results back to those who provided the data or using them to inform quality improvement efforts. Of these, only one advocated for public reporting of their results 39 . The other 67 studies were performed purely for academic purposes.…”

Section: Discussionmentioning

confidence: 99%

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Quality indicators in surgical oncology: systematic review of measures used to compare quality across hospitals

McLeod,

Leung,

Pramesh

et al. 2024

BJS Open

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Background Measurement and reporting of quality indicators at the hospital level has been shown to improve outcomes and support patient choice. Although there are many studies validating individual quality indicators, there has been no systematic approach to understanding what quality indicators exist for surgical oncology and no standardization for their use. The aim of this study was to review quality indicators used to assess variation in quality in surgical oncology care across hospitals or regions. It also sought to describe the aims of these studies and what, if any, feedback was offered to the analysed groups. Methods A literature search was performed to identify studies published between 1 January 2000 and 23 October 2023 that applied surgical quality indicators to detect variation in cancer care at the hospital or regional level. Results A total of 89 studies assessed 91 unique quality indicators that fell into the following Donabedian domains: process indicators (58; 64%); outcome indicators (26; 29%); structure indicators (6; 7%); and structure and outcome indicators (1; 1%). Purposes of evaluating variation included: identifying outliers (43; 48%); comparing centres with a benchmark (14; 16%); and supplying evidence of practice variation (29; 33%). Only 23 studies (26%) reported providing the results of their analyses back to those supplying data. Conclusion Comparisons of quality in surgical oncology within and among hospitals and regions have been undertaken in high-income countries. Quality indicators tended to be process measures and reporting focused on identifying outlying hospitals. Few studies offered feedback to data suppliers.

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“…The present study suggested the distribution of the age, differentiated grade, T stage, N stage, M stage, and metastatic organ number showed marked differences between the patients with and without surgery, which was consistent with the previous studies. 17 , 18 Many methods such as multivariable Cox regression and instrumental variable method were recommended to adjust the effect of these confounding factors. However, none of these methods alone could entirely avoid the bias.…”

Section: Discussionmentioning

confidence: 99%

Not all Rectal Cancer Patients Could Benefit From the Surgery on the Primary Site

Zhou

Xia

et al. 2023

Cancer Control

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Aim Previous studies have provided evidence that primary site surgery can improve the prognosis of rectal cancer patients, even in those with advanced age and distant metastasis, though results have been inconsistent. The current study aims to determine if all rectal cancer patients are likely to benefit from surgery in terms of overall survival. Methods This study examined the impact of primary site surgery on the prognosis of rectal cancer patients diagnosed between 2010 and 2019 using multivariable Cox regression analysis. The study also stratified patients by age group, M stage, chemotherapy, radiotherapy, and number of distant metastatic organs. The propensity score matching method was used to balance observed covariates between patients who received and did not receive surgery. The Kaplan–Meier method was used to analyze the data, and the log-rank test was used to determine differences between patients who did and did not undergo surgery. Results The study included 76,941 rectal cancer patients, with a median survival of 81.0 months (95% CI: 79.2–82.8 months). Of these patients, 52,360 (68.1%) received primary site surgery, and they tended to be younger, have higher differentiated grade, earlier T, N, M stage, and lower rates of bone, brain, lung, and liver metastasis, chemotherapy, and radiotherapy than those without surgery. Multivariable Cox regression analysis revealed that surgery had a protective effect on the prognosis of rectal cancer patients, including those with advanced age, distant metastasis, and multiple organ metastasis, but not in patients with four organ metastases. The results were also confirmed using propensity score matching. Conclusion Not all rectal cancer patients could benefit from the surgery on the primary site, especially the patients with more than four distant metastases. The results could help the clinicians to tailor targeted treatment regimens and provide a guideline for making surgical decisions.

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

Cited by 8 publications

References 27 publications

Not all rectal cancer patients could benefit from the surgery on the primary site

Not all rectal cancer patients could benefit from the surgery on the primary site

Quality indicators in surgical oncology: systematic review of measures used to compare quality across hospitals

Not all Rectal Cancer Patients Could Benefit From the Surgery on the Primary Site

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