Volume–outcome analysis of colorectal cancer-related outcomes

Borowski, David W; Bradburn, D. M.; Mills, S; Bharathan, Balamurali; Wilson, Robert; Ratcliffe, Amy; Kelly, S. B.

doi:10.1002/bjs.7111

Cited by 157 publications

(93 citation statements)

References 70 publications

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“…Surgical technique might also be of concern, as there is a surprisingly high rate of leaks from the colonic anastomoses, amounting to about 10%. This may explain the postoperative mortality of 4.2% for all patients, which does not compare well to even population-based figures [19] .…”

Section: Commentary On Hot Articlesmentioning

confidence: 60%

Non-steroidal anti-inflammatory drugs in colorectal surgery: A risk factor for anastomotic complications?

Rutegård

Rutegård²

2012

WJGS

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In a recent article, Gorissen et al report on 795 patients with primary colorectal anastomosis operated on during the period 2008-2010 for different colorectal conditions at two centres. The leakage rate was significantly higher among patients who were administered non-steroidal anti-inflammatory drugs (NSAIDs) in the perioperative course. A dose-response relationship could also be traced, where longer NSAID use yielded a higher risk of anastomotic breakdown. However, as this study is observational in design, confounding by indication may be present and there is also a risk of residual confounding from unmeasured covariates. Moreover, the question whether different affinity for the cyclooxygenase enzyme is important in different NSAIDs seems to be largely unanswered. The results, conclusions and clinical relevance of the aforementioned study, including the possible effects of different types of NSAIDs, are discussed. While acknowledging that this study represents the best attempt so far in establishing the causal relationship between perioperative NSAID use and anastomotic leakage, the need for further research in this important area is underlined.

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Section: Commentary On Hot Articlesmentioning

confidence: 60%

Non-steroidal anti-inflammatory drugs in colorectal surgery: A risk factor for anastomotic complications?

Rutegård

Rutegård²

2012

WJGS

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“…Many factors influence survival from colorectal cancer, including diagnosis or treatment centre (see Kee et al, (1999) on the influence of hospital and clinician workload; McArdle & Hole (2004) on volume and specialisation; and Borowski et al (2010) for a volume-outcome analysis), stage at diagnosis (see Woodman, Gibbs, Scott, Haboubi, & Collins (2001) on differences in stage at presentation; and Ciccolallo et al (2005) on the role of stage and surgery), and associated risk factors such as socioeconomic background, age at diagnosis and sex (see Morris et al (2011) for thirty-day postoperative mortality; Downing et al (2013) for early mortality; Smith et al (2006) on the impact of social deprivation; Widdison, Barnett, & Betambeau (2011) on age;and Hendifar et al (2009) on gender disparities). Findings exploring the potential impact of socioeconomic background (SEB) vary, with some studies showing an impact of poor SEB on decreased colorectal cancer survival (Downing et al, 2013;Morris et al, 2011), whilst others do not find this association (Nur et al, 2008;Smith et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Multilevel Latent Class Modelling of Colorectal Cancer Survival Status at Three Years and Socioeconomic Background Whilst Incorporating Stage of Disease

Harrison

Gilthorpe²,

Downing³

et al. 2013

IJSP

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Previous studies investigating survival from colorectal cancer have typically considered potential confounders to include stage of disease. Stage however may lie on the causal path and statistical adjustment with stage as a confounder can then introduce bias known as the reversal paradox. Classification of stage may also be imprecise and incomplete. Modelling using Latent Class Analysis (LCA) may minimise bias by including covariates on the causal path as 'class predictors' and by accommodating uncertainty associated with confounder values explicitly via the latent class part of the model. We construct multilevel latent class models to allow for the multilevel structure of the data: patients nested within NHS Trusts. We use a dataset of patients in a large UK regional population diagnosed with colorectal cancer between 1998 and 2004. Death within three years is the outcome. The optimum number of latent classes at patient and Trust level is determined with reference to likelihood-based modelfit criteria. The three-patient five-Trust class multilevel LCA model was chosen. Patient classes were identified as good, reasonable or poor prognosis groups. The impact of stage differed across the patient classes. Socioeconomic background and older age were clearly associated with increased odds of death in all patient classes. Females had significantly decreased odds of death compared with males in the good prognosis class. The five Trust classes identified outlying Trusts, indicating that the standard multilevel model would not have been sufficient to model these data.

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“…A nastomotic leakage remains a feared and frequent complication in gastrointestinal surgery, especially for anastomoses on the colon and rectum, with leakage rates of 3% to 7% and 13%, respectively, [1][2][3][4][5] leading to a mortality rate of up to 27%. 1,6 In addition to existing interventions used to decrease the risk of anastomotic leakage, such as altered surgical techniques, preoperative optimization, and different postoperative regimens, anastomotic coating has been suggested as a potential method.…”

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confidence: 99%

Decreased Leakage Rate of Colonic Anastomoses by Tachosil Coating: An Experimental Study

Pommergaard

Achiam

Burcharth

et al. 2014

International Surgery

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Colorectal anastomotic coating has been proposed as a means to lower the leakage rate. Prior to clinical testing, coating materials need thorough experimental evaluation to ensure safety and efficacy. The aim of this study was to evaluate Tachosil as an anastomotic coating agent. Technically insufficient colon anastomoses were created in 80 C57BL/6 mice, and in half of the animals the anastomoses were covered with Tachosil. The animals were examined for clinical signs of anastomotic leakage, and the breaking strength of the anastomoses was evaluated. The number of leakages was reduced by Tachosil coating (10/40 versus 20/40 in controls; P ¼ 0.037). However, more cases of large bowel obstruction were found in the Tachosil group (12/40 versus 0/40 in controls; P , 0.0005). Breaking strength was comparable between the Tachosil and control groups (0.49 N versus 0.52 N, respectively; P ¼ 0.423). Clinical studies are needed to clarify the efficacy of Tachosil anastomotic coating.Key words: Colon anastomotic leakage -Anastomotic dehiscence -Anastomotic failureAnimal model -Experimental -Coating -Tachosil -Sealing A nastomotic leakage remains a feared and frequent complication in gastrointestinal surgery, especially for anastomoses on the colon and rectum, with leakage rates of 3% to 7% and 13%, respectively, 1-5 leading to a mortality rate of up to 27%. 1,6 In addition to existing interventions used to decrease the risk of anastomotic leakage, such as altered surgical techniques, preoperative optimization, and different postoperative regimens, anastomotic coating has been suggested as a potential method.7 Numerous experimental studies evaluating anastomotic coating have reported positive effects; however, contradictory results were found when the same coating material was evaluated by other researchers or in a different study design. Furthermore, a few coating materials have been evaluated in humans, but without convincing 7 In order to establish a rationale for conducting large, clinical, randomized, controlled trials in which specific coating agents are evaluated, positive results have to be reproduced in several animal studies to ensure the safety and efficacy of the materials and methods. Tachosil (Hakeda, Osaka, Japan) has been evaluated in a technically insufficient anastomosis in a mouse model by Pantelis et al. 8 This study reported the positive result that Tachosil reduced the anastomotic leakage rate from 36.7% to 5.9%. These results, together with the findings of other studies, 9,10 suggest that Tachosil is one of the most promising agents for colorectal anastomotic coating.The aim of this study was to evaluate the use of Tachosil to lower the anastomotic leakage rate in a mouse model of the technically insufficient colon anastomosis. Furthermore, we aimed to investigate if the results produced by Pantelis et al 8 were reproducible in our setting. Materials and MethodsEnd-to-end colonic anastomoses were created in 80 male C57BL/6 mice (23-30 g). The animals were anesthetized with isoflurane (isoflurane, 2%...

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Volume–outcome analysis of colorectal cancer-related outcomes

Abstract: This study has confirmed the relevance of minimum volume standards for individual surgeons. Organization of services in high-volume units may improve survival in patients with rectal cancer.

Cited by 157 publications

References 70 publications

Non-steroidal anti-inflammatory drugs in colorectal surgery: A risk factor for anastomotic complications?

Non-steroidal anti-inflammatory drugs in colorectal surgery: A risk factor for anastomotic complications?

Multilevel Latent Class Modelling of Colorectal Cancer Survival Status at Three Years and Socioeconomic Background Whilst Incorporating Stage of Disease

Decreased Leakage Rate of Colonic Anastomoses by Tachosil Coating: An Experimental Study

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