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Rectal cancer surgery: volume-outcome analysis.

Emmeline Nugent¹, Paul Neary

¹National Surgical Training Centre, Royal College of Surgeons Ireland, 121 St. Stephen's Green, Dublin 2, Ireland. emmelinenugent@rcsi.ie

International Journal of Colorectal Disease

|July 28, 2010

Summary

The volume-outcome relationship for rectal cancer surgery is unclear. Specialized high-volume colorectal surgeons improve patient outcomes, including sphincter preservation and local recurrence rates, though volume doesn't directly impact mortality or morbidity.

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Area of Science:

Surgical Oncology
Gastroenterology
Public Health

Background:

The volume-outcome relationship is established for lung and pancreatic cancers.
Evidence for rectal cancer surgery remains limited.
Understanding caseload impact is crucial for optimizing patient care.

Purpose of the Study:

To review the literature on the volume-outcome relationship in rectal cancer surgery.
To assess the impact of hospital and surgeon volume on patient outcomes.
To clarify the evidence base for rectal cancer surgical caseloads.

Main Methods:

Systematic literature review of Medline (PubMed) database (1997-2009).
Keywords: rectal cancer, hospital volume, surgeon volume, outcomes, mortality, morbidity, local recurrence.
Included 18 articles analyzing short-term morbidity and long-term outcomes (sphincter preservation, mortality, local recurrence).

Main Results:

High-volume hospitals and surgeons showed shorter postoperative stays and more sphincter-preserving surgeries.
Surgeon specialization significantly influenced outcomes (sphincter preservation, survival, local recurrence).
No negative association between volume and mortality; positive association with local recurrence. No link between caseload and postoperative morbidity.

Conclusions:

Limited evidence exists for the volume-outcome relationship in rectal cancer surgery.
High-volume institutions correlate with shorter hospital stays.
Specialized high-volume colorectal surgeons achieve superior outcomes for rectal cancer patients.