Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 2/2013

01-02-2013 | Original Article

Volume and outcome in rectal cancer surgery: the importance of quality management

Authors: Werner Hohenberger, Susanne Merkel, Paul Hermanek

Published in: International Journal of Colorectal Disease | Issue 2/2013

Login to get access

Abstract

Purpose

For many years, the impact of the surgeon volume on short- and long-term outcome after rectal carcinoma surgery is controversially discussed. Literature and own department data were reviewed in order to clarify the impact of surgeon volume in the current era of total mesorectal excision surgery, multimodal therapy, quality management, and centralization of cancer care.

Methods

Uni- and multivariate analysis of data from 1,028 patients with solitary rectal carcinoma, treated between 1995 and 2010 at the Department of Surgery, University Hospital, Erlangen, Germany, was performed. Surgeons were subdivided according to the number of operations/year into high- (at least seven/year), medium- (three to six), and low- (less than three) volume surgeons.

Results

Of 1,028 patients, 800 (77.8 %) were operated by five high-volume surgeons, 193 (18.8 %) by seven medium-volume surgeons, and 35 (3.4 %) by 12 low-volume surgeons. Surgeon volume was significantly associated with postoperative mortality and the rate of positive pathological circumferential resection margin. In risk-adjusted analysis, after primary surgery, surgeon volume had a significant impact on observed overall survival and disease-free survival, but not on locoregional recurrence. After neoadjuvant radiochemotherapy, only observed overall survival was significantly influenced by surgeon volume.

Conclusions

In surgical departments with special interest in rectal carcinoma, surgeon volume has some influence on short- and long-term outcome. Irrespective of this fact, specialization, experience, individual skill, hospital organization, and regular quality assurance are essential prognostic factors ensuring good results in rectal carcinoma surgery.
Literature
1.
Meagher AP (1999) Colorectal cancer: is the surgeon a prognostic factor? A systematic review. Med J Aust 20(171):308–310
2.
Iversen LH, Harling H, Laurberg S, Wille-Jørgensen P (2007) Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence. Part 1: short-term outcome. Colorectal Dis 9:28–37PubMedCrossRef
3.
Iversen LH, Harling H, Laurberg S, Wille-Jørgensen P, Danish Colorectal Cancer Group (2007) Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence. Part 2: long-term outcome. Colorectal Dis 9:38–46PubMedCrossRef
4.
Salz T, Sandler RS (2008) The effect of hospital and surgeon volume on outcomes for rectal cancer surgery. Clin Gastroenterol Hepatol 6:1185–1193PubMedCrossRef
5.
Archampong D, Borowski DW, Dickinson HO (2010) Impact of surgeon volume on outcomes of rectal cancer surgery: a systematic review and meta-analysis. Surgeon 8:341–352PubMedCrossRef
6.
Archampong D, Borowski D, Wille-Jørgensen P, Iversen LH (2012) Workload and surgeon's specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev. 2012;3:CD005391
7.
Gospodarowicz MK, Hermanek P, Henson DE (1995) (1995) Introduction. In: Hermanek P, Gospodarowicz MK, Henson DE, Hutter RVP, Sobin LH (eds) In: UICC Prognostic factors in cancer. Springer, Berlin, pp 1–11CrossRef
8.
Gospodarowicz MK, O'Sullivan B (2001) Prognostic factors: principles and application. In: Gospodarowicz MK, Henson DE, Hutter RVP, O'Sullivan B, Sobin L, Wittekind CH (eds) UICC. Prognostic factors in Cancer. 2nd ed. Wiley, New York, pp 17–35
9.
10.
Hobday TJ, Erlichman CE (2001) Colorectal cancer. In: Gospodarowicz MK, Henson DE, Hutter RVP, O'Sullivan B, Sobin L, Wittekind C (eds) UICC. Prognostic factors in Cancer. 2nd ed. Wiley, New York, pp 267–279
11.
Compton CC (2006) Colorectal cancer. In: Gospodarowicz MK, O’Sullivan B, Sobin LH (eds) UICC. Prognostic factors in cancer, 3rd ed. Wiley, New York, pp 133–137
12.
Archampong D, Borowski DW (2012) Impact of hospital volume on outcomes of rectal cancer surgery: a systematic review and meta-analysis. Int J Colorectal Dis in press
13.
Heald RJ, Husband EM, Ryall RDH (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616PubMedCrossRef
14.
15.
Hohenberger W, Merkel S, Matzel K, Bittorf B, Papadopoulos T, Goehl J (2006) The influence of abdomino-peranal (intersphincteric) resection of lower third rectal carcinoma on the rates of sphincter preservation and locoregional recurrence. Colorectal Dis 8:23–33PubMedCrossRef
16.
Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740PubMedCrossRef
17.
Rödel C, Liersch T, Becker H et al (2012) Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol 13:679–687PubMedCrossRef
18.
Schmiegel W, Reinacher-Schick A, Arnold D et al (2008) S3-Leitlinie Kolorektales Karzinom – Aktualisierung 2008. Ergebnis einer evidenzbasierten Konsensuskonferenz (8.–9. Juni 2007). Z Gastroenterol 46:799–840PubMedCrossRef
19.
UICC (2009) TNM classification of malignant tumors. 7th ed. (Sobin LH, Gospodarowicz MK, Wittekind Ch, eds) Wiley, Oxford, UK
20.
Fielding LP, Stewart-Brown S, Dudley HA (1978) Surgeon-related variables and the clinical trial. Lancet 2(8093):778–779PubMedCrossRef
21.
Phillips RKS, Hittinger R, Blesovsky L, Fry JS, Fielding LP (1984) Local recurrence following 'curative' surgery for large bowel cancer: I. The overall picture. Br J Surg 71:12–16PubMedCrossRef
22.
McArdle CS, Hole D (1991) Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival. BMJ 302:1501–1505PubMedCrossRef
23.
Hermanek P, Wiebelt H, Staimmer D, Riedl S (1995) Prognostic factors of rectum carcinoma—experience of the German Multicentre Study SGCRC. German Study Group Colo-Rectal Carcinoma. Tumori 81(3 Suppl):60–64PubMed
24.
Hermanek P, Hohenberger W (1996) The importance of volume in colorectal cancer surgery. Eur J Surg Oncol 22:213–215PubMedCrossRef
25.
Hohenberger W (1997) The effect of specialization or organization of rectal cancer surgery. In: Soreide O, Norstein J (eds) Rectal cancer surgery—optimization, standardization, documentation. Springer, Berlin, pp 353–363CrossRef
26.
Hermanek P (1999) Impact of surgeon's technique on outcome after treatment of rectal carcinoma. Dis Colon Rectum 42:559–562PubMedCrossRef
27.
Hermanek P, Sobin LH (1995) Colorectal carcinoma. In: Hermanek P, Gospodarowicz MK, Henson DE, Hutter RVP, Sobin L (eds) UICC. Prognostic factors in cancer. 1st ed. Springer, Berlin, pp 64–79CrossRef
28.
Bilimoria KY, Phillips JD, Rock CE, Hayman A, Prystowsky JB, Bentrem DJ (2009) Effect of surgeon training, specialization, and experience on outcomes for cancer surgery: a systematic review of the literature. Ann Surg Oncol 16:1799–1808PubMedCrossRef
29.
Möhner M, Slisów W (1990) Effect of regional centralized treatment on chances of survival in rectal cancer in East Germany. Zentralbl Chir 115:801–812PubMed
30.
Påhlman L, Bohe M, Cedermark B et al (2007) The Swedish rectal cancer registry. Br J Surg 94:1285–1292PubMedCrossRef
31.
Larson DW, Marcello PW, Larach SW et al (2008) Surgeon volume does not predict outcomes in the setting of technical credentialing: results from a randomized trial in colon cancer. Ann Surg 248:746–750PubMedCrossRef
32.
Kapiteijn E, Putter H, van de Velde CJ, Cooperative investigators of the Dutch ColoRectal Cancer Group (2002) Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in The Netherlands. Br J Surg 89:1142–1149PubMedCrossRef
33.
Martling A, Cedermark B, Johansson H, Rutqvist LE, Holm T (2002) The surgeon as a prognostic factor after the introduction of total mesorectal excision in the treatment of rectal cancer. Br J Surg 89:1008–1013PubMedCrossRef
34.
Hermanek P, Mansmann U, Staimmer DS, Riedl S, Hermanek P (2000) The German experience: the surgeon as a prognostic factor in colon and rectal cancer surgery. Surg Oncol Clin N Am 9:33–49PubMed
35.
Hogan AM, Kennelly R, Winter DC (2009) Volume-outcome analysis in rectal cancer: a plea for enquiry, evidence and evolution. Eur J Surg Oncol 35:111–112PubMedCrossRef
36.
37.
Schrag D, Panageas KS, Riedel E, Cramer LD, Guillem JG, Bach PB, Begg CB (2002) Hospital and surgeon procedure volume as predictors of outcome following rectal cancer resection. Ann Surg 236:583–592PubMedCrossRef
38.
Borowski DW, Bradburn DM, Mills SJ, Bharathan B, Wilson RG, Ratcliffe AA, Kelly SB, Northern Region Colorectal Cancer Audit Group (NORCCAG) (2010) Volume-outcome analysis of colorectal cancer-related outcomes. Br J Surg 97:1416–1430PubMedCrossRef
39.
Rogers SO Jr, Ayanian JZ, Ko CY, Kahn KL, Zaslavsky AM, Sandler RS, Keating NL (2009) Surgeons' volume of colorectal cancer procedures and collaborative decision-making about adjuvant therapies. Ann Surg 250:895–900PubMedCrossRef
40.
Compton CC, Fielding LP, Burgart LJ et al (2000) Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 124:979–994PubMed
41.
Merkel S, Mansmann U, Hohenberger W, Hermanek P (2011) Time to locoregional recurrence after curative resection of rectal carcinoma is prolonged after neoadjuvant treatment: a systematic review and meta-analysis. Colorectal Dis 13:123–131PubMedCrossRef
Metadata
Title
Volume and outcome in rectal cancer surgery: the importance of quality management
Authors
Werner Hohenberger
Susanne Merkel
Paul Hermanek
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 2/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-012-1596-2

Other articles of this Issue 2/2013

International Journal of Colorectal Disease 2/2013 Go to the issue

Letter to the Editor

Letter to the Editor concerning: Hawkins M, Billingham R, Bastawrous A. Hemorrhoid management in patients with radiation proctitis. Int J Colorectal Dis. 2012 Jun 20. [Epub ahead of print]

Original Article

Downregulation of microRNA-124 is an independent prognostic factor in patients with colorectal cancer

Letter to the Editor

Gastrointestinal involvement in Stevens–Johnson syndrome: prompt recognition and successful treatment

Letter to the Editor

Association of epigenetic alteration in PTEN gene with colorectal cancer progression among Indian population

Review

Colon carcinoma in childhood: review of the literature with four case reports

Original Article

The role of colonic mast cells and myenteric plexitis in patients with diverticular disease