Influence of hospital volume on local recurrence and survival in a population sample of rectal cancer patients

A nationwide audit of the use of radiotherapy for rectal cancer in Italy

“…In a study limited to elderly patients, Rogers et al already observed that high-volume centers were more likely to use radiotherapy for rectal cancer but did not separate pre from postoperative [29]. Our findings are similar to those of a German audit and probably reflect that indication and delivery of neoadjuvant therapy is logistically easier in high-volume centers where patients are assessed by a multidisciplinary team [30] and radiotherapy facility are more accessible. Some have proposed to identify a subgroup of high-risk patients (males with low lying cancers) that are more likely to benefit from a high-volume cancer care center [31].…”

“…It is however necessary for future studies to take into account the mode of radiotherapy delivery as this has been shown to significantly impact local recurrence and survival [33]. Even if the difference between neoadjuvant treatment between high-volume and low-volume centers found by Engel et al was highly significant, it is remarkable that no differences in survival or other outcome were noted [30], indicating that there are other factors more important in determining the treatment outcome for rectal cancer patients. Navigator programs to overcome socio economic and geographic differences have been available in the United States for over a decade with measurable beneficial results in terms of time to diagnosis and survival rate [34].…”

CPT-11 and concomitant hyperfractionated accelerated radiotherapy induce efficient local control in rectal cancer patients: results from a phase II

“…Since the introduction of total mesorectal excision (TME) which includes the resection of the entire mesorectal fascia, local recurrences are reported in 5 -17% of the patients, depending on the experience of the centre, of the surgeon and whether neoadjuvant treatment has been applied or not (Janjan et al, 1998;Kockerling et al, 1998;Kapiteijn et al, 2001;Glimelius et al, 2003;Bosset et al, 2005;Engel et al, 2005;Gerard et al, 2005;Marijnen et al, 2005). This is in sharp contrast to former conventional surgery without additional treatment options, which were associated with local recurrence rates of up to 40% (Pahlman and Glimelius, 1990;MacFarlane et al, 1993).…”

Variation in treatment and outcome of patients with rectal cancer by region, hospital type and volume in the Netherlands

“…[1,2,[10][11][12] However, the association between volume and outcome for rectal cancer surgery is not that clear: some reported lower postoperative mortality or better overall survival in patients who were operated in a high-volume hospital, while others did not find such relationship. [13][14][15][16] Studies examining the relation between type of hospital and outcome also published contrasting results for rectal cancer. [14,[17][18][19] The aim of this study was to describe variation in treatment patterns and outcome according to region and characteristics of individual hospitals among patients with rectal cancer in the Netherlands.…”