Key result
Colorectal cancer surgery in low-volume centres was associated with a higher rate of severe postoperative complications compared to higher-volume centres (OR 1.50; 95% CI 1.15-1.096; P=0.003).
Why the study?
Does low hospital volume increase severe complications and worsen pathological outcomes in patients undergoing colorectal cancer surgery?
Observational (n=16,883)
Yes
Does low hospital volume increase severe complications and worsen pathological outcomes in patients undergoing colorectal cancer surgery?
Odds Ratio: 1.5 (95% CI 1.15–1.096)
p-value: p=0.003
Colorectal cancer surgery performed in low-volume centers is associated with higher rates of severe postoperative complications and suboptimal oncologic resections compared to very high-volume centers.
This is the authors' abstract. We don't add key points for this paper.
BACKGROUND: The association between volume, complications and pathological outcomes is still under debate regarding colorectal cancer surgery. The aim of the study was to assess the association between centre volume and severe complications, mortality, less-than-radical oncologic surgery, and indications for neoadjuvant therapy. METHODS: Retrospective analysis of 16,883 colorectal cancer cases from 80 centres (2018-2021). Outcomes: 30-day mortality; Clavien-Dindo grade >2 complications; removal of ≥ 12 lymph nodes; non-radical resection; neoadjuvant therapy. Quartiles of hospital volumes were classified as LOW, MEDIUM, HIGH, and VERY HIGH. Independent predictors, both overall and for rectal cancer, were evaluated using logistic regression including age, gender, AJCC stage and cancer site. RESULTS: LOW-volume centres reported a higher rate of severe postoperative complications (OR 1.50, 95% c.i. 1.15-1.096, P = 0.003). The rate of ≥ 12 lymph nodes removed in LOW-volume (OR 0.68, 95% c.i. 0.56-0.85, P < 0.001) and MEDIUM-volume (OR 0.72, 95% c.i. 0.62-0.83, P < 0.001) centres was lower than in VERY HIGH-volume centres. Of the 4676 rectal cancer patients, the rate of ≥ 12 lymph nodes removed was lower in LOW-volume than in VERY HIGH-volume centres (OR 0.57, 95% c.i. 0.41-0.80, P = 0.001). A lower rate of neoadjuvant chemoradiation was associated with HIGH (OR 0.66, 95% c.i. 0.56-0.77, P < 0.001), MEDIUM (OR 0.75, 95% c.i. 0.60-0.92, P = 0.006), and LOW (OR 0.70, 95% c.i. 0.52-0.94, P = 0.019) volume centres (vs. VERY HIGH). CONCLUSION: Colorectal cancer surgery in low-volume centres is at higher risk of suboptimal management, poor postoperative outcomes, and less-than-adequate oncologic resections. Centralisation of rectal cancer cases should be taken into consideration to optimise the outcomes.
Low-volume centres associated with higher complications and suboptimal resections; supports volume-outcome hypothesis but leaves open need for prospective confirmation.
No takes yet. Share an insight, caveat, or question.
Rottoli et al. (2023) conducted an observational in Colorectal cancer (n=16,883). Low hospital volume vs. Very high hospital volume was evaluated on Severe postoperative complications (Clavien-Dindo grade >2) (OR 1.50, 95% CI 1.15-1.096, p=0.003). Colorectal cancer surgery in low-volume centres was associated with a higher rate of severe postoperative complications compared to higher-volume centres (OR 1.50; 95% CI 1.15-1.096; P=0.003).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: