Systematic review and a meta-analysis of hospital and surgeon volume/outcome relationships in colorectal cancer surgery

Lee

et al. 2020

Sci Rep

the role of laparoscopic surgery for left-sided colon cancer has been supported by the results of randomized controlled trials. However, its benefits and disadvantages in the real world setting should be further assessed with population-based studies.the hospitalization data of patients undergoing open or laparoscopic surgery for left-sided colon cancer were sourced from the taiwan national Health insurance Research Database. patient and hospital characteristics and perioperative outcomes including length of hospital stay, operation time, opioid use, blood transfusion, intensive care unit (ICU) admission, and use of mechanical ventilation were compared. The overall survival was also assessed. patients undergoing laparoscopic surgery had shorter hospital stay (p < 0.0001) and less demand for opioid analgesia (p = 0.0005). Further logistic regression revealed that patients undergoing open surgery were 1.70, 2.89, and 3.00 times more likely to have blood transfusion, to be admitted to ICU, and to use mechanical ventilation than patients undergoing laparoscopic surgery. Operations performed in medical centers were also associated with less adverse events. the overall survival was comparable between the 2 groups.With adequate hospital quality and volume, laparoscopic surgery for left-sided colon cancer was associated with improved perioperative outcomes. the long-term survival was not compromised.Colorectal cancer is a worldwide health problem. It is the 3rd most commonly diagnosed malignancy in the world and is also one of leading causes of cancer death 1 . Laparoscopic colectomy was introduced in 1991 2 . Initially, it was not widely accepted for cancer treatment because of technical difficulties such as working in multiple intra-abdominal quadrants, ligation of vessels and re-establishment of intestinal continuity as well as oncological concerns including retrieval of lymph nodes, surgical resection margin and survival results 3 . These controversies gradually settled with the accumulation of experience and advance in technology. Through medial-to-lateral approach, the difficulty of multi-quadrant working was lessened. New energy devices such as bipolar sealers and ultrasonic shears made ligation of vessels easier. For oncologic concerns, laparoscopic colectomy was accepted as an alternative surgical approach for colon cancer after positive outcomes from several multi-center prospective randomized trials (RCTs) 4-8 . Since then, further evidence has accumulated to support the feasibility, safety, and benefits of the laparoscopic surgery for colorectal cancer 9-11 .

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of clinical outcomes between laparoscopic and open surgery for left-sided colon cancer: a nationwide population-based study

Lee

et al. 2020

Sci Rep

“…12 Although the data assessing volume outcomes for rectal cancer are inconsistent, with some studies showing a relationship and others not, low volumes of rectal cancer cases could prove to be a problem if surgeons are trying to add TaTME to their skill set. [13][14][15][16][17] Indeed, 25% of our cohort of surgeons who operated on 8 or fewer rectal cancer cases per year said they planned to learn TaTME. This might reflect access-to-care constraints in Canada, where patients living in rural and remote areas often have difficulty accessing cancer centres or specialist centres that are located at considerable distances from their communities.…”

Section: Discussionmentioning

confidence: 99%

“…(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) 9(5)(6)(7)(8)(9)(10) IQR = interquartile range; TaTME = transanal total mesorectal excision. *Surgeons who were performing TaTME at the time of the survey.†Surgeons who were not performing TaTME at the time of the survey.…”

mentioning

confidence: 99%

Implementing new surgical technology: a national perspective on case volume requirement for proficiency in transanal total mesorectal excision

Palter

Montbrun

2020

CJS

Background: Early data suggest that transanal total mesorectal excision (TaTME) is a safe alternative to the abdominal approach for rectal cancer. This study aims to understand the approach to the management of rectal cancer in Canada and to ascertain perspectives on introducing TaTME. Methods: Surgeons were invited to complete a survey that asked about their management practices relating to rectal cancer and their opinions regarding TaTME. Results: Ninety-four surgeons completed the survey (38% response rate). The number of rectal cancer cases handled annually by surgeons varied widely (1-80 cases, median 15 cases). Twenty-seven percent of respondents performed TaTME at the time of the survey, and 43% of those who did not said they planned on learning the technique. Surgeons who performed TaTME felt that a higher annual volume of rectal cancer cases was required to maintain proficiency than did non-TaTME surgeons (median 20 cases [interquartile range (IQR) 15-25 cases] v. 15 cases [IQR 10-20 cases]). Surgeons who performed TaTME also felt that a higher annual volume of TaTME cases was required to maintain proficiency (median 12 cases [IQR 10-19 cases] v. 9 cases [IQR 5-10 cases]). Conclusion: These findings help define the current practice environment for rectal cancer surgeons in Canada and highlight the complex issues associated with learning TaTME. Contexte : Selon des données préliminaires, l'exérèse totale du mésorectum par voie transanale (ou TaTME, pour transanal total mesorectal excision) est une solution de rechange sécuritaire à l'approche abdominale pour le cancer du rectum. Cette étude vise à faire le point sur le traitement du cancer rectal au Canada et à mesurer l'intérêt à l'endroit de la technique TaTME. Méthodes : Des chirurgiens ont été invités à répondre à un sondage sur leur façon de prendre en charge le cancer rectal et sur leur opinion au sujet de la TaTME.

“…Decision-making in choice of upfront treatment modalities, surgical options and adjuvant care requires a multidisciplinary meeting for optimal outcomes. 1,2 Several studies have reported a significant association between high hospital volumes and lower mortality, [3][4][5][6][7][8] while others have not found an association. 9,10 One such study from France recommended centralization of rectal cancer surgery to improve postoperative mortality rates.…”

Section: Introductionmentioning

confidence: 99%

State‐wide outcomes in elective rectal cancer resection: is there a case for centralization in Victoria?

Hong

Watters

Faragher

2019

ANZ Journal of Surgery

Background The role of service centralization in rectal cancer surgery is controversial. Recent studies suggest centralization to high‐volume centres may improve postoperative mortality. We used a state‐wide administrative data set to determine the inpatient mortality for patients undergoing elective rectal cancer surgery and to compare individual hospital volumes. Methods The Victorian Admitted Episodes Dataset was explored using the Dr Foster Quality Investigator tool. The inpatient mortality rate, 30‐day readmission rate and the proportion of patients with increased length of stay were measured for all elective admissions for rectal cancer resections between 2012 and 2016. A peer group of 14 hospitals were studied using funnel plots to determine inter‐hospital variation in mortality. Procedure types were compared between the groups. Results There were 2241 elective resections performed for rectal cancer in Victoria over 4 years. The crude inpatient mortality rate was 1.1%. There were no significant differences in mortality among 14 hospitals within the peer group. The number of elective resections over 4 years ranged from 14 to 136 (median 65) within these institutions. Ultralow anterior resection was the commonest procedure performed. Conclusion Inpatient mortality after elective rectal cancer surgery in Victoria is rare and compares favourably internationally. Based on inpatient mortality alone, there is no compelling evidence to further centralize elective rectal cancer surgery in Victoria. More work is needed to develop data sets with oncological information capable of providing accurate complete state‐wide data which will be essential for future service planning, training and innovation.