Volume and outcome in colorectal cancer surgery

Abstract

AimsThere is a growing consensus to concentrate high-risk surgical procedures to highvolume surgeons in high-volume hospitals. However, there is fierce debate about centralizing more common malignancies such as colorectal cancer. The objective of this review is to conduct a meta-analysis using the best evidence available on the volume-outcome relationship for colorectal cancer treatment. MethodsA systematic search was performed to identify all relevant articles studying the relation between hospital and/or surgeon volume and clinical outcomes for colorectal cancer. Using strict inclusion criteria, 23 articles were selected concerning colon cancer, rectal cancer or both diseases together as 'colorectal cancer'. Pooled estimated effect sizes were calculated using the casemix adjusted outcomes of the highest volume group opposed to the lowest volume group. Results High ConclusionsThe results show a clear and consistent relation between high volume providers and improved long term survival. This applies to both high volume hospitals and high volume surgeons. Most results show a relation between high volume providers and a reduced postoperative mortality, but evidence is less convincing.In the ideal world, extensive population based audit registrations with casemix adjusted feedback should make rigid minimal volume standards obsolete. Until then, using volume criteria for hospitals and surgeons treating colorectal cancer can improve mortality and especially long term survival.

Low rates of complications for carotid artery stenting are associated with a high clinician volume of carotid artery stenting and aortic endografting but not with a high volume of percutaneous coronary interventions

“…[1][2][3][4][5][6][7][8][9] For vascular procedures, increasing surgeon volume has been associated with improved outcomes for carotid endarterectomy, elective open abdominal aortic aneurysm (AAA) repair, open and endovascular repair of ruptured AAAs, thoracoabdominal aortic aneurysm repair, and lower extremity bypass. 1,2,[9][10][11][12][13][14] Recent articles have reported that clinician volume may also affect the outcomes for carotid artery stenting (CAS).…”

Minimum Volume Discussion in the Treatment of Colon and Rectal Cancer: A Review of the Current Status and Relevance of Surgeon and Hospital Volume regarding Result Quality and the Impact on Health Economics

“…However, two of these papers also come to the conclusion that the impact of volume on outcome 'may be' positive when correlated to HVH [11,12] (these authors found a positive correlation for HVS). The estimation 'maybe' is made by one group only for the category HVS [13], but not for HVH.…”

“…In CC, two authors each support a positive correlation between volume and treatment quality in favor ('pro') of either HVH [9,10] or HVS [11,12] with respect to short-term outcome. However, two of these papers also come to the conclusion that the impact of volume on outcome 'may be' positive when correlated to HVH [11,12] (these authors found a positive correlation for HVS).…”

“…Doubt ('maybe') is expressed as to the correlations of HVH [12,[16][17][18] or HVS [19] to short-term quality and regarding long-term quality in HVH [17] or HVS [19]. Three authors reject correlations [14,20,21].…”

“…These authors reject a correlation between volume and quality for HVH. Only two statements are given concerning the correlation of volume to long-term results, one with 'pro' for HVH but 'maybe' for HVS [12]. Another group gives an ambiguous statement for HVS [14].…”