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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 12/2010

01-12-2010 | Review

Rectal cancer surgery: volume–outcome analysis

Authors: Emmeline Nugent, Paul Neary

Published in: International Journal of Colorectal Disease | Issue 12/2010

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Abstract

Purpose

There is strong evidence supporting the importance of the volume–outcome relationship with respect to lung and pancreatic cancers. This relationship for rectal cancer surgery however remains unclear. We review the currently available literature to assess the evidence base for volume outcome in relation to rectal cancer surgery.

Methods

We analysed the Medline “PubMed” online database using the keyword search parameters of “rectal cancer”, “hospital volume or caseload”, “surgeon volume or caseload”, “outcomes”, “mortality”, “approach”, “local recurrence” and “morbidity” for the time period 1997–2009. Five hundred twenty-six generic articles were identified. Articles that were not specific for, or separately identified, rectal cancer surgery in their individual analysis were excluded. Eighteen articles remained for review. We assessed short-term morbidity and long-term outcomes such as sphincter preservation, mortality and local recurrence rates.

Results

Considerable variance was noted in the definition of high volume and low volume. Postoperative length of stay was lower and sphincter-preserving surgery was more commonly performed in high-volume hospitals and by high-volume surgeons. Surgeon specialisation was an important factor influencing sphincter preservation, survival and local recurrence rates. Volume was found to have no negative relationship with mortality and a positive one with local recurrence. Interestingly, there was no association found between hospital or surgeon caseload and postoperative morbidity.

Conclusion

There is a paucity of evidence in the literature regarding the volume–outcome relationship with regard to rectal cancer surgery. High-volume institutions yielded shorter lengths of stay. However, the key finding was that high-volume surgeons that specialised in colorectal surgery yielded objectively improved outcomes for patients with rectal cancer.
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Metadata
Title
Rectal cancer surgery: volume–outcome analysis
Authors
Emmeline Nugent
Paul Neary
Publication date
01-12-2010
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 12/2010
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-010-1019-1

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