直肠癌治疗中保肛率的医院差异：荷兰基于人群的研究结果。
Hospital variation in sphincter-preservation rates in rectal cancer treatment: results of a population-based study in the Netherlands.
机构信息
Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Surgery, Maasziekenhuis Pantein, Boxmeer, The Netherlands.
出版信息
BJS Open. 2021 Jul 6;5(4). doi: 10.1093/bjsopen/zrab065.
BACKGROUND
This study aimed to examine the sphincter-preservation rate variations in rectal cancer surgery. The influence of hospital volume on sphincter-preservation rates and short-term outcomes (anastomotic leakage (AL), positive circumferential resection margin (CRM), 30- and 90-day mortality rates) were also analysed.
METHODS
Non-metastasized rectal cancer patients treated between 2009 and 2016 were selected from the Netherlands Cancer Registry. Surgical procedures were divided into sphincter-preserving surgery and an end colostomy group. Multivariable logistic regression models were generated to estimate the probability of undergoing sphincter-preserving surgery according to the hospital of surgery and tumour height (low, 5 cm or less, mid, more than 5 cm to 10 cm, and high, more than 10 cm). The influence of annual hospital volume (less than 20, 20-39, more than 40 resections) on sphincter-preservation rate and short-term outcomes was also examined.
RESULTS
A total of 20 959 patients were included (11 611 sphincter preservation and 8079 end colostomy) and the observed median sphincter-preservation rate in low, mid and high rectal cancer was 29.3, 75.6 and 87.9 per cent respectively. After case-mix adjustment, hospital of surgery was a significant factor for patients' likelihood for sphincter preservation in all three subgroups (P < 0.001). In mid rectal cancer, borderline higher rates of sphincter preservation were associated with low-volume hospitals (odds ratio 1.20, 95 per cent c.i. 1.01 to 1.43). No significant association between annual hospital volume and sphincter-preservation rate in low and high rectal cancer nor short-term outcomes (AL, positive CRM rate and 30- and 90-day mortality rates) was identified.
CONCLUSION
This population-based study showed a significant hospital variation in sphincter-preservation rates in rectal surgery. The annual hospital volume, however, was not associated with sphincter-preservation rates in low, and high rectal cancer nor with other short-term outcomes.
背景
本研究旨在探讨直肠癌手术中保肛率的变化。还分析了医院容量对保肛率和短期结果（吻合口漏（AL）、阳性环周切缘（CRM）、30 天和 90 天死亡率）的影响。
方法
从荷兰癌症登记处选择了 2009 年至 2016 年间治疗的非转移性直肠癌患者。手术分为保肛手术和结肠造口术组。多变量逻辑回归模型用于根据手术医院和肿瘤高度（低位，5cm 或以下；中位，5cm 至 10cm 之间；高位，10cm 以上）估计接受保肛手术的概率。还检查了每年医院容量（<20、20-39、>40 例）对保肛率和短期结果的影响。
结果
共纳入 20959 例患者（11611 例保肛和 8079 例结肠造口术），低位、中位和高位直肠癌的观察保肛率中位数分别为 29.3%、75.6%和 87.9%。在病例混合调整后，手术医院是所有三个亚组中患者保肛可能性的重要因素（P<0.001）。在中位直肠癌中，保肛率略高与低容量医院相关（优势比 1.20，95%置信区间 1.01 至 1.43）。未发现年度医院容量与低位和高位直肠癌保肛率以及短期结果（AL、阳性 CRM 率以及 30 天和 90 天死亡率）之间存在显著相关性。
结论
这项基于人群的研究表明，直肠癌手术中保肛率存在显著的医院差异。然而，年度医院容量与低位和高位直肠癌的保肛率以及其他短期结果无关。
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