Gietelink Lieke, Henneman Daniel, van Leersum Nicoline J, de Noo Mirre, Manusama Eric, Tanis Pieter J, Tollenaar Rob A E M, Wouters Michel W J M
*Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands †Department of Surgery, Rijnland Hospital, Leiderdorp, The Netherlands ‡Department of Surgery, Deventer Hospital, Deventer, The Netherlands §Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands ¶Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands ||Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
Ann Surg. 2016 Apr;263(4):745-50. doi: 10.1097/SLA.0000000000001009.
This population-based study evaluates the association between hospital volume and CRM (circumferential resection margin) involvement, adjusted for other confounders, in rectal cancer surgery. A low hospital volume (<20 cases/year) was independently associated with a higher risk of CRM involvement (odds ratio=1.54; 95% CI: 1.12-2.11).
To evaluate the association between hospital volume and CRM (circumferential resection margin) involvement in rectal cancer surgery.
To guarantee the quality of surgical treatment of rectal cancer, the Association of Surgeons of the Netherlands has stated a minimal annual volume standard of 20 procedures per hospital. The influence of hospital volume has been examined for different outcome variables in rectal cancer surgery. Its influence on the pathological outcome (CRM) however remains unclear. As long-term outcomes are best predicted by the CRM status, this parameter is of essential importance in the debate on the justification of minimal volume standards in rectal cancer surgery.
Data from the Dutch Surgical Colorectal Audit (2011-2012) were used. Hospital volume was divided into 3 groups, and baseline characteristics were described. The influence of hospital volume on CRM involvement was analyzed, in a multivariate model, between low- and high-volume hospitals, according to the minimal volume standards.
This study included 5161 patients. CRM was recorded in 86% of patients. CRM involvement was 11% in low-volume group versus 7.7% and 7.9% in the medium- and high-volume group (P≤0.001). After adjustment for relevant confounders, the influence of hospital volume on CRM involvement was still significant odds ratio (OR) = 1.54; 95% CI: 1.12-2.11).
The outcomes of this pooled analysis support minimal volume standards in rectal cancer surgery. Low hospital volume was independently associated with a higher risk of CRM involvement (OR = 1.54; 95% CI: 1.12-2.11).
这项基于人群的研究评估了直肠癌手术中，医院手术量与环周切缘（CRM）受累情况之间的关联，并对其他混杂因素进行了校正。低手术量医院（每年<20例）与CRM受累风险较高独立相关（比值比=1.54；95%置信区间：1.12 - 2.11）。
评估直肠癌手术中医院手术量与CRM（环周切缘）受累情况之间的关联。
为保证直肠癌手术治疗质量，荷兰外科医生协会规定每家医院每年的最低手术量标准为20例。已针对直肠癌手术中不同的结局变量研究了医院手术量的影响。然而，其对病理结局（CRM）的影响仍不明确。由于长期结局最佳预测指标是CRM状态，该参数在关于直肠癌手术最低手术量标准合理性的争论中至关重要。
使用荷兰结直肠手术审计（2011 - 2012年）的数据。将医院手术量分为3组，并描述基线特征。根据最低手术量标准，在多变量模型中分析低手术量医院与高手术量医院之间手术量对CRM受累情况的影响。
本研究纳入5161例患者。86%的患者记录了CRM。低手术量组CRM受累率为11%，而中手术量组和高手术量组分别为7.7%和7.9%（P≤0.001）。在对相关混杂因素进行校正后，手术量对CRM受累情况的影响仍然显著（比值比（OR）=1.54；95%置信区间：1.12 - 2.11）。
这项汇总分析的结果支持直肠癌手术的最低手术量标准。低医院手术量与CRM受累风险较高独立相关（OR = 1.54；95%置信区间：1.12 - 2.11）。
