2000 年以来直肠癌患者接受治疗的情况下，医院和外科医生手术量与直肠癌手术结果之间的关联：系统文献回顾和荟萃分析。
Association Between Hospital and Surgeon Volume and Rectal Cancer Surgery Outcomes in Patients With Rectal Cancer Treated Since 2000: Systematic Literature Review and Meta-analysis.
机构信息
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa.
Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa.
出版信息
Dis Colon Rectum. 2018 Nov;61(11):1320-1332. doi: 10.1097/DCR.0000000000001198.
BACKGROUND
Previous reviews and meta-analyses, which predominantly focused on patients treated before 2000, have reported conflicting evidence about the association between hospital/surgeon volume and rectal cancer outcomes. Given advances in rectal cancer resection, such as total mesorectal excision, it is essential to determine whether volume plays a role in rectal cancer outcomes among patients treated since 2000.
OBJECTIVE
The purpose of this study was to determine whether there is an association between hospital/surgeon volume and rectal cancer surgery outcomes among patients treated since 2000.
DATA SOURCES
We searched PubMed and EMBASE for articles published between January 2000 and December 29, 2017.
STUDY SELECTION
Articles that analyzed the association between hospital/surgeon volume and rectal cancer outcomes were selected.
INTERVENTION
Rectal cancer resection was the study intervention.
MAIN OUTCOME MEASURES
The outcome measures of this study were surgical morbidity, postoperative mortality, surgical margin positivity, permanent colostomy rates, recurrence, and overall survival.
RESULTS
Although 2845 articles were retrieved and assessed by the search strategy, 21 met the inclusion and exclusion criteria. There was a significant protective association between higher hospital volume and surgical morbidity (OR = 0.80 (95% CI, 0.70-0.93); I = 35%), permanent colostomy (OR = 0.51 (95% CI, 0.29-0.92); I = 34%), and postoperative mortality (OR = 0.62 (95% CI, 0.43-0.88); I = 34%), and overall survival (OR = 0.99 (95% CI, 0.98-1.00); I = 3%). Stratified analysis showed that the magnitude of association between hospital volume and rectal cancer surgery outcomes was stronger in the United States compared with other countries. Surgeon volume was not significantly associated with overall survival. The articles included in this analysis were high quality according to the Newcastle-Ottawa scale. Funnel plots suggested that the potential for publication bias was low.
LIMITATIONS
Some articles included rectosigmoid cancers.
CONCLUSIONS
Among patients diagnosed since 2000, higher hospital volume has had a significant protective effect on rectal cancer surgery outcomes.
背景
之前的综述和荟萃分析主要集中在 2000 年以前治疗的患者，报告了医院/外科医生手术量与直肠癌结局之间的关联存在相互矛盾的证据。鉴于直肠切除术的进步，如全直肠系膜切除术，确定 2000 年以后治疗的患者中手术量是否与直肠癌结局相关至关重要。
目的
本研究旨在确定 2000 年以后治疗的患者中，医院/外科医生手术量与直肠癌手术结局之间是否存在关联。
数据来源
我们检索了 PubMed 和 EMBASE 数据库，以获取 2000 年 1 月至 2017 年 12 月 29 日期间发表的文章。
研究选择
选择分析医院/外科医生手术量与直肠癌结局之间关联的文章。
干预措施
直肠切除术是研究干预措施。
主要观察指标
本研究的观察指标为手术发病率、术后死亡率、手术切缘阳性率、永久性结肠造口率、复发率和总生存率。
结果
虽然通过搜索策略检索到 2845 篇文章，并进行了评估，但仅有 21 篇符合纳入和排除标准。较高的医院量与手术发病率（比值比[OR] = 0.80，95%置信区间[CI]，0.70-0.93；I² = 35%）、永久性结肠造口（OR = 0.51，95% CI，0.29-0.92；I² = 34%）和术后死亡率（OR = 0.62，95% CI，0.43-0.88；I² = 34%）以及总生存率（OR = 0.99，95% CI，0.98-1.00；I² = 3%）呈显著保护关联。分层分析显示，与其他国家相比，美国医院量与直肠癌手术结局之间的关联程度更强。外科医生手术量与总生存率无显著相关性。根据纽卡斯尔-渥太华量表，本分析纳入的文章质量较高。漏斗图表明发表偏倚的可能性较低。
局限性
部分文章纳入了直肠乙状结肠癌。
结论
在 2000 年以后诊断的患者中，较高的医院量对直肠癌手术结局有显著的保护作用。
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