Volume-outcome relationship in rectal cancer surgery.

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Health Services Research

Background:

• Hospital centralization is theorized to improve outcomes for complex surgeries like colorectal procedures.
• However, a clear volume-outcome relationship for rectal cancer surgery remains underexplored.
• This study investigates the impact of increased surgical volume on early outcomes following laparoscopic anterior rectal resection.

Purpose of the Study:

• To evaluate the effect of increased surgical volume on early outcomes in patients undergoing laparoscopic restorative anterior rectal resection (ARR).
• To compare anastomotic leak rates and other short-term outcomes before and after the centralization of rectal cancer services.

Main Methods:

• Retrospective analysis of consecutive patients undergoing ARR with primary anastomosis.
• Comparison of outcomes between a high-volume period (post-centralization) and a lower-volume period (pre-centralization).
• Primary outcome: anastomotic leak rate. Secondary outcomes: operative time, conversion rates, blood transfusion, complications, length of stay, reoperation, mortality, and stoma rates.

Main Results:

• A significant increase in surgical volume was observed after centralization (p=0.019).
• The anastomotic leak rate was significantly lower in the higher-volume period (p=0.047).
• Mean operative time, conversion rates, blood transfusion needs, and in-hospital stay were significantly reduced in the high-volume group (p<0.05).

Conclusions:

• Increased surgical volume in rectal cancer surgery is associated with a reduced anastomotic leak rate.
• Centralization of rectal cancer surgery can lead to improved perioperative outcomes.
• Optimizing surgical unit volume may be crucial for achieving the best patient results.