结直肠癌相关结局的量效关系分析。

Volume-outcome analysis of colorectal cancer-related outcomes.

机构信息

Department of Surgery, North Tyneside General Hospital, North Shields, UK.

出版信息

Br J Surg. 2010 Sep;97(9):1416-30. doi: 10.1002/bjs.7111.

DOI:10.1002/bjs.7111

PMID:20632311

Abstract

BACKGROUND

Significant associations between caseload and surgical outcomes highlight the conflict between local cancer care and the need for centralization. This study examined the effect of hospital volume on short-term outcomes and survival, adjusting for the effect of surgeon caseload.

METHODS

Between 1998 and 2002, 8219 patients with colorectal cancer were identified in a regional population-based audit. Outcomes were assessed using univariable and multivariable analysis to allow case mix adjustment. Surgeons were categorized as low (26 or fewer operations annually), medium (27-40) or high (more than 40) volume. Hospitals were categorized as low (86 or fewer), medium (87-109) or high (more than 109) volume.

RESULTS

Some 7411 (90.2 per cent) of 8219 patients underwent surgery with an anastomotic leak rate of 2.9 per cent (162 of 5581), perioperative mortality rate of 8.0 per cent (591 of 7411) and 5-year survival rate of 46.8 per cent. Medium- and high-volume surgeons were associated with significantly better operative mortality (odds ratio (OR) 0.74, P = 0.010 and OR 0.66, P = 0.002 respectively) and survival (hazard ratio (HR) 0.88, P = 0.003 and HR 0.93, P = 0.090 respectively) than low-volume surgeons. Rectal cancer survival was significantly better in high-volume versus low-volume hospitals (HR 0.85, P = 0.036), with no difference between medium- and low-volume hospitals (HR 0.96, P = 0.505).

CONCLUSION

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.

摘要

背景

病例量与手术结果之间存在显著关联，这突显了局部癌症治疗与集中化需求之间的冲突。本研究通过调整外科医生手术量的影响，检验了医院容量对短期结果和生存的影响。

方法

在 1998 年至 2002 年期间，对一个区域性基于人群的审计中确定的 8219 例结直肠癌患者进行了评估。使用单变量和多变量分析来评估结果，以允许病例组合调整。外科医生分为低（每年 26 例或更少）、中（27-40 例）或高（超过 40 例）手术量。医院分为低（86 例或更少）、中（87-109 例）或高（超过 109 例）手术量。

结果

8219 例患者中有 7411 例（90.2%）接受了手术，吻合口漏的发生率为 2.9%（5581 例中有 162 例），围手术期死亡率为 8.0%（7411 例中有 591 例），5 年生存率为 46.8%。中、高手术量的外科医生的手术死亡率明显较低（比值比（OR）0.74，P=0.010 和 OR 0.66，P=0.002），生存率也较高（风险比（HR）0.88，P=0.003 和 HR 0.93，P=0.090），与低手术量的外科医生相比。与低手术量医院相比，高手术量医院的直肠癌生存率显著提高（HR 0.85，P=0.036），而中手术量与低手术量医院之间没有差异（HR 0.96，P=0.505）。