The Influence of Hospital Volume on Circumferential Resection Margin Involvement

Gietelink, Lieke; Henneman, D.; Leersum, N.J. van; Noo, Mirre de; Manusama, Eric R.; Tanis, Pieter J.; Tollenaar, Rob A.E.M.; Wouters, Michel W. J. M.

doi:10.1097/sla.0000000000001009

Cited by 45 publications

(18 citation statements)

References 23 publications

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“…• The controversy around institutional volume of cases is not settled. However, there is evidence to indicate that concentrated skills and expertise play a pivotal role in short and long-term surgical and oncological outcomes in the management of patients with rectal cancer [23][24][25]. TaTME should only be performed at centers with expertise in "complex" rectal cancer surgery as per CPAC guidelines [22]…”

Section: Settingmentioning

confidence: 99%

Canadian taTME expert collaboration (CaTaCO) position statement

et al. 2020

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Introduction Transanal total mesorectal excision (taTME) is a novel approach to surgery for rectal cancer. The technique has gained significant popularity in the surgical community due to the promising ability to overcome technical difficulties related to the access of the distal pelvis. Recently, Norwegian surgeons issued a local moratorium related to potential issues with the safety of the procedure. Early adopters of taTME in Canada have recognized the need to create guidelines for its adoption and supervision. The objective of the statement is to provide expert opinion based on the best available evidence and authors' experience. Methods The procedure has been performed in Canada since 2014 at different institutions. In 2016, the first Canadian taTME congress was held in the city of Toronto, organized by two of the authors. In early 2019, a multicentric collaborative was established [The Canadian taTME expert Collaboration] which aimed at ensuring safe performance and adoption of taTME in Canada. Recently surgeons from 8 major Canadian rectal cancer centers met in the city of Toronto on December 7 of 2019, to discuss and develop a position statement. There in person, meeting was followed by 4 rounds of Delphi methodology. Results The generated document focused on the need to ensure a unified approach among rectal cancer surgeons across the country considering its technical complexity and potential morbidity. The position statement addressed four domains: surgical setting, surgeons' requirements, patient selection, and quality assurance. Conclusions Authors agree transanal total mesorectal excision is technically demanding and has a significant risk for morbidity. As of now, there is uncertainty for some of the outcomes. We consider it is possible to safely adopt this operation and obtain adequate results, however for this purpose it is necessary to meet specific requirements in different domains.

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Section: Settingmentioning

confidence: 99%

Canadian taTME expert collaboration (CaTaCO) position statement

et al. 2020

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“…In contrast to the present findings, an independent association of CRM positivity and hospital volume was documented in a study including more than 5000 rectal cancer patients undergoing primary resection in 2011–2012. A 1.5-fold higher risk of CRM involvement was observed in low-volume hospitals 30 . Another Dutch study with data from 2008 to 2013 collected from 10 community hospitals in the Southern Netherlands did not, however, show significantly higher CRM involvement in hospitals performing 20 or fewer rectal cancer surgeries per year (low-volume) compared with hospitals executing at least 40 per year (high-volume) 31 .…”

Section: Discussionmentioning

confidence: 91%

Hospital variation in sphincter-preservation rates in rectal cancer treatment: results of a population-based study in the Netherlands

et al. 2021

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Background This study aimed to examine the sphincter-preservation rate variations in rectal cancer surgery. The influence of hospital volume on sphincter-preservation rates and short-term outcomes (anastomotic leakage (AL), positive circumferential resection margin (CRM), 30- and 90-day mortality rates) were also analysed. Methods Non-metastasized rectal cancer patients treated between 2009 and 2016 were selected from the Netherlands Cancer Registry. Surgical procedures were divided into sphincter-preserving surgery and an end colostomy group. Multivariable logistic regression models were generated to estimate the probability of undergoing sphincter-preserving surgery according to the hospital of surgery and tumour height (low, 5 cm or less, mid, more than 5 cm to 10 cm, and high, more than 10 cm). The influence of annual hospital volume (less than 20, 20–39, more than 40 resections) on sphincter-preservation rate and short-term outcomes was also examined. Results A total of 20 959 patients were included (11 611 sphincter preservation and 8079 end colostomy) and the observed median sphincter-preservation rate in low, mid and high rectal cancer was 29.3, 75.6 and 87.9 per cent respectively. After case-mix adjustment, hospital of surgery was a significant factor for patients’ likelihood for sphincter preservation in all three subgroups (P < 0.001). In mid rectal cancer, borderline higher rates of sphincter preservation were associated with low-volume hospitals (odds ratio 1.20, 95 per cent c.i. 1.01 to 1.43). No significant association between annual hospital volume and sphincter-preservation rate in low and high rectal cancer nor short-term outcomes (AL, positive CRM rate and 30- and 90-day mortality rates) was identified. Conclusion This population-based study showed a significant hospital variation in sphincter-preservation rates in rectal surgery. The annual hospital volume, however, was not associated with sphincter-preservation rates in low, and high rectal cancer nor with other short-term outcomes.

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“…A total of 3012 studies were examined, and 23 comprising 293,159 minimally invasive oncologic surgeries met the inclusion criteria and were used for the descriptive analysis [ 4 , 5 , 6 , 7 , 8 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. The study selection schema is shown in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Among the 23 studies, gastrointestinal surgery was the most common surgery type (nine studies) [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], followed by genitourinary (seven studies) [ 30 , 31 , 32 , 33 , 34 , 35 , 36 ], gynecologic (four studies) [ 4 , 5 , 6 , 7 ], hepatobiliary (two studies) [ 8 , 29 ], and thoracic (one study) surgeries [ 37 ]. In the gynecologic surgery group, two studies reported the outcomes of minimally invasive hysterectomy in endometrial cancer [ 4 , 6 ].…”

Section: Resultsmentioning

confidence: 99%

“…Studies included in this review were published from 2009 to 2020. The study duration corresponding to these studies ranged from 1997 to 2015, but 22 of the 23 studies used a starting point of the 2000s [ 4 , 5 , 6 , 7 , 8 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. The majority of studies were from the United States (69.6%) [ 4 , 5 , 6 , 7 , 8 , 20 , 21 , 24 , 25 , 29 , 30 , 32 , 33 , 34 , 35 , 37 ], followed by Europe (17.4%) [ 22 , 28 , 31 , 36 ] and Japan (13.0%) [ 23 , 26 , 27 ].…”

Section: Resultsmentioning

confidence: 99%

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Minimally Invasive Surgery and Surgical Volume-Specific Survival and Perioperative Outcome: Unmet Need for Evidence in Gynecologic Malignancy

Matsuzaki

Klar

Chang

et al. 2021

JCM

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This study examined the effect of hospital surgical volume on oncologic outcomes in minimally invasive surgery (MIS) for gynecologic malignancies. The objectives were to assess survival outcomes related to hospital surgical volume and to evaluate perioperative outcomes and examine non-gynecologic malignancies. Literature available from the PubMed, Scopus, and the Cochrane Library databases were systematically reviewed. All surgical procedures including gynecologic surgery with hospital surgical volume information were eligible for analysis. Twenty-three studies met the inclusion criteria, and nine gastro-intestinal studies, seven genitourinary studies, four gynecological studies, two hepatobiliary studies, and one thoracic study were reviewed. Of those, 11 showed a positive volume–outcome association for perioperative outcomes. A study on MIS for ovarian cancer reported lower surgical morbidity in high-volume centers. Two studies were on endometrial cancer, of which one showed lower treatment costs in high-volume centers and the other showed no association with perioperative morbidity. Another study examined robotic-assisted radical hysterectomy for cervical cancer and found no volume–outcome association for surgical morbidity. There were no gynecologic studies examining the association between hospital surgical volume and oncologic outcomes in MIS. The volume–outcome association for oncologic outcome in gynecologic MIS is understudied. This lack of evidence calls for further studies to address this knowledge gap.

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The Influence of Hospital Volume on Circumferential Resection Margin Involvement

Abstract: The outcomes of this pooled analysis support minimal volume standards in rectal cancer surgery. Low hospital volume was independently associated with a higher risk of CRM involvement (OR = 1.54; 95% CI: 1.12-2.11).

Cited by 45 publications

References 23 publications

Canadian taTME expert collaboration (CaTaCO) position statement

Canadian taTME expert collaboration (CaTaCO) position statement

Hospital variation in sphincter-preservation rates in rectal cancer treatment: results of a population-based study in the Netherlands

Minimally Invasive Surgery and Surgical Volume-Specific Survival and Perioperative Outcome: Unmet Need for Evidence in Gynecologic Malignancy

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