Welten Vanessa M, Wanis Kerollos N, Madenci Arin L, Fields Adam C, Lu Pamela W, Malizia Robert A, Yoo James, Goldberg Joel E, Irani Jennifer L, Bleday Ronald, Melnitchouk Nelya
Division of General and Gastrointestinal Surgery, Department of Surgery Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, MA, 02115, Boston, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, MA, 02120, Boston, USA.
J Gastrointest Surg. 2022 Jan;26(1):150-160. doi: 10.1007/s11605-021-05092-0. Epub 2021 Jul 21.
Prior studies assessing colorectal cancer survival have reported better outcomes when operations are performed at high-volume centers. These studies have largely been cross-sectional, making it difficult to interpret their estimates. We aimed to assess the effect of facility volume on survival following proctectomy for rectal cancer.
Using data from the National Cancer Database, we included all patients with complete baseline information who underwent proctectomy for non-metastatic rectal cancer between 2004 and 2016. Facility volume was defined as the number of rectal cancer cases managed at the treating center in the calendar year prior to the patient's surgery. Overall survival estimates were obtained for facility volumes ranging from 10 to 100 cases/year. Follow-up began on the day of surgery and continued until loss to follow-up or death.
A total of 52,822 patients were eligible. Patients operated on at hospitals with volumes of 10, 30, and 50 cases/year had similar distributions of grade, clinical stage, and neoadjuvant therapies. 1-, 3-, and 5-year survival all improved with increasing facility volume. One-year survival was 94.0% (95% CI: 93.7, 94.3) for hospitals that performed 10 cases/year, 94.5% (95% CI: 94.2, 94.7) for 30 cases/year, and 94.8% (95% CI: 94.5, 95.0) for 50 cases/year. Five-year survival was 68.9% (95% CI: 68.0, 69.7) for hospitals that performed 10 cases/year, 70.8% (95% CI: 70.1, 71.5) for 30 cases/year, and 72.0% (95% CI: 71.2, 72.8) for 50 cases/year.
Treatment at a higher volume facility results in improved survival following proctectomy for rectal cancer, though the small benefits are less profound than previously reported.
先前评估结直肠癌生存率的研究报告称，在高容量中心进行手术时预后更佳。这些研究大多是横断面研究，难以解读其评估结果。我们旨在评估医疗机构手术量对直肠癌直肠切除术后生存率的影响。
利用国家癌症数据库的数据，我们纳入了2004年至2016年间所有接受非转移性直肠癌直肠切除术且基线信息完整的患者。医疗机构手术量定义为患者手术前一自然年在治疗中心管理的直肠癌病例数。获得了每年手术量在10至100例之间的医疗机构的总体生存估计值。随访从手术当天开始，持续至失访或死亡。
共有52,822例患者符合条件。在每年手术量为10例、30例和50例的医院接受手术的患者，其分级、临床分期和新辅助治疗的分布相似。1年、3年和5年生存率均随着医疗机构手术量的增加而提高。每年进行10例手术的医院，1年生存率为94.0%（95%CI：93.7，94.3）；每年进行30例手术的医院，1年生存率为94.5%（95%CI：94.2，94.7）；每年进行50例手术的医院，1年生存率为94.8%（95%CI：94.5，95.0）。每年进行10例手术的医院，5年生存率为68.9%（95%CI：68.0，69.7）；每年进行30例手术的医院，5年生存率为70.8%（95%CI：70.1，71.5）；每年进行50例手术的医院，5年生存率为72.0%（95%CI：71.2，72.8）。
在手术量较高的医疗机构进行治疗可提高直肠癌直肠切除术后的生存率，不过其微小益处不如先前报告的那么显著。
