Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France.
GRC6-UPMC : Centre Expert En Endométriose (C3E), Paris, France.
Surg Endosc. 2018 Apr;32(4):2003-2011. doi: 10.1007/s00464-017-5896-z. Epub 2017 Oct 24.
National and international guidelines recommend referring patients with severe forms of endometriosis to expert centers. However, there is a lack of clear criteria to define an expert center. We examined the roles of surgeon and hospital procedure volumes as determinants of morbidity in deep infiltrating endometriosis of the rectum and sigmoid colon (DIERS).
We conducted a French retrospective multicenter study of hospital facilities performing colorectal surgery for DIERS in 2015. The primary end point was to analyze the relation between case volume and the incidence of complications. We estimated the optimal cut-off (OCO) determined by a minimal p-value approach.
The study included 56 hospital facilities and collected data of 1135 cases of surgical management of colorectal endometriosis. The mean and median number of procedures per year and per surgeon were 9.17 and 5.58, respectively. The overall rate of grade III-V complication was 7.6% (82/1135). One grade V complication occurred. The rates of rectovaginal fistula, anastomotic leakage, pelvic abscess, and ureteral fistula were: 2.7% (31/1135), 0.79% (9/1135), 3.4% (39/1135), and 0.70% (8/1135), respectively. An OCO of 20 procedures per center and per year (p < 0.001) was defined. The OCO per surgeon and per year varied between seven (p = 0.007) and 13 procedures (p = 0.03). In a multivariate analysis, we found that only the volume of activity was independently correlated to complication outcomes (p = 0.0013).
Our results contribute to providing objective morbidity data to determine criteria for defining expert centers for colorectal surgery for endometriosis.
本研究旨在探讨外科医生和医院手术量作为直肠和乙状结肠深部浸润性子宫内膜异位症（DIERS）患者发病率决定因素的作用。
我们进行了一项法国回顾性多中心研究，纳入了 2015 年进行 DIERS 结肠直肠手术的医院设施。主要终点是分析病例量与并发症发生率之间的关系。我们通过最小 p 值方法估计了最佳截止值（OCO）。
该研究共纳入 56 家医院设施，共收集了 1135 例手术治疗结直肠子宫内膜异位症的数据。每年每位外科医生的手术量平均值和中位数分别为 9.17 和 5.58。总体 III-V 级并发症发生率为 7.6%（82/1135）。发生 1 例 V 级并发症。直肠阴道瘘、吻合口漏、盆腔脓肿和输尿管瘘的发生率分别为 2.7%（31/1135）、0.79%（9/1135）、3.4%（39/1135）和 0.70%（8/1135）。定义了中心每年每 20 例手术的 OCO（p<0.001）。每位外科医生每年的 OCO 介于 7 例（p=0.007）和 13 例之间（p=0.03）。在多变量分析中，我们发现只有活动量与并发症结果独立相关（p=0.0013）。
我们的研究结果为确定结直肠子宫内膜异位症手术专家中心的标准提供了客观的发病率数据。
