Volume-outcome relationship in rectal cancer surgery

Volume-outcome relationship in rectal cancer surgery

Introduction Hospital centralization effect is reported to lower complications and mortality for high risk and complex surgery operations, including colorectal surgery. However, no linear relation between volume and outcome has been demonstrated. Aim of the study was to evaluate the increased surgic...

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Published in:Discover. Oncology Vol. 12; no. 1; p. 11
Main Authors: Siragusa, L., Sensi, B., Vinci, D., Franceschilli, M., Pathirannehalage Don, C., Bagaglini, G., Bellato, V., Campanelli, M., Sica, G. S.
Format: Journal Article
Language:English
Published: New York Springer US 12-04-2021
Springer Nature B.V
Subjects:
Cancer Research
Cancer therapies
Colorectal cancer
Disease
Hemoglobin
Hospitals
Internal Medicine
Laparoscopy
Medicine
Medicine & Public Health
Molecular Medicine
Morbidity
Mortality
Oncology
Ostomy
Patients
Pneumonia
Radiotherapy
Recovery (Medical)
Surgical anastomosis
Surgical Oncology
Surgical site infections
Rectal cancer
Volume/outcome
Anastomotic leak
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Summary:Introduction Hospital centralization effect is reported to lower complications and mortality for high risk and complex surgery operations, including colorectal surgery. However, no linear relation between volume and outcome has been demonstrated. Aim of the study was to evaluate the increased surgical volume effect on early outcomes of patient undergoing laparoscopic restorative anterior rectal resection (ARR). Methods A retrospective analysis of all consecutive patients undergoing ARR with primary anastomosis between November 2016 and December 2020 after centralization of rectal cancer cases in an academic Centre. Short-term outcomes are compared to those of patients operated in the same unit during the previous 10 years before service centralization. The primary outcome was estimated anastomotic leak rate. Mean operative time, need of conversion, postoperative use of blood transfusion, radicality, in-hospital stay, number and type of complications, readmission and reoperation rate, mortality and 1-year and stoma persistence rates were evaluated as secondary outcomes. Results 86 patients were operated in the study period and outcomes compared to those of 101 patients operated during the previous ten years. Difference in volume of surgery was significant between the two periods (p 0.019) and the estimated leak rate was significantly lower in the higher volume unit (p 0.047). Mean operative time, need of conversion, postoperative use of blood transfusion and in-hospital stay (p < 0.05) were also significantly reduced in Group A. Conclusion This study suggests that the shift toward higher volume in rectal cancer surgery is associated to decreased anastomotic leak rate. Potentiation of lower volume surgical units may yield optimal perioperative outcomes.
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ISSN:2730-6011
2730-6011
DOI:10.1007/s12672-021-00406-9