Tanaka Masahiro, Kanemitsu Yukihide, Ueno Hideki, Kobayashi Hirotoshi, Konishi Tsuyoshi, Ishida Fumio, Yamaguchi Tatsuro, Hinoi Takao, Inoue Yasuhiro, Tomita Naohiro, Ishida Hideyuki, Sugihara Kenichi
Colorectal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Department of Surgery, National Defense Medical College, Saitama, Japan.
Int J Colorectal Dis. 2017 Oct;32(10):1489-1498. doi: 10.1007/s00384-017-2885-6. Epub 2017 Aug 22.
Many studies have shown that hospital volume is significantly associated with short- and long-term outcomes in various diseases, including cancer. However, there have been no reports discussing the relationship between hospital volume and familial adenomatous polyposis (FAP). This study aimed to clarify whether hospital volume affects short- and long-term outcomes in FAP patients.
We established a retrospectively collected database of FAP patients who underwent initial surgical treatment at 23 Japanese institutions during 2000-2012. Factors associated with short- and long-term outcomes were analyzed.
The study cohort included 303 FAP patients. These patients were classified into tertile categories according to hospital volume: low (n = 31), middle (n = 72), and high volume (n = 200). The proportion of only adenoma/stage 0 was comparable among tertile categories. The adoption of operative procedure significantly differed among tertile categories; specifically, high-volume institutions preferred handsewn ileal pouch-anal anastomosis without diverting ileostomy (P < 0.001 and < 0.001, respectively). Nevertheless, the frequency of complications with Clavien-Dindo classification grade ≥ 3 was not significantly different among tertile categories. Functional results were acceptable in every category. Wexner scores were significantly lower in high-volume compared to low-volume institutions (P = 0.02). Multivariate analyses showed that UICC stage and hospital volume were significantly associated with overall survival (P = 0.04 and 0.03, respectively).
Hospital volume was significantly associated with short- and long-term outcomes in FAP patients.
许多研究表明，医院规模与包括癌症在内的各种疾病的短期和长期预后显著相关。然而，尚无报告讨论医院规模与家族性腺瘤性息肉病（FAP）之间的关系。本研究旨在阐明医院规模是否会影响FAP患者的短期和长期预后。
我们建立了一个回顾性收集的数据库，纳入了2000年至2012年期间在23家日本机构接受初次手术治疗的FAP患者。分析了与短期和长期预后相关的因素。
研究队列包括303例FAP患者。这些患者根据医院规模分为三分位数类别：低规模（n = 31）、中等规模（n = 72）和高规模（n = 200）。三分位数类别中仅腺瘤/0期的比例相当。手术方式的采用在三分位数类别之间有显著差异；具体而言，高规模机构更倾向于采用手工缝合的回肠袋肛管吻合术且不进行转流性回肠造口术（分别P < 0.001和< 0.001）。然而，Clavien-Dindo分级≥ 3级的并发症发生率在三分位数类别之间无显著差异。各分类中的功能结果均可接受。与低规模机构相比，高规模机构的Wexner评分显著更低（P = 0.02）。多因素分析显示，国际抗癌联盟（UICC）分期和医院规模与总生存期显著相关（分别P = 0.04和0.03）。
医院规模与FAP患者的短期和长期预后显著相关。
