Colorectal Dis. 2023 May;25(5):923-931. doi: 10.1111/codi.16505. Epub 2023 Feb 21.
There is scant evidence regarding surgical outcomes of patients with colon cancer in Latin America. The aim of this work was to compare perioperative (30 day) outcomes of patients undergoing surgery for right colon cancer in Latin America based on centre volume.
This is a multi-institutional retrospective cohort study. Individuals operated on for right colon cancer with curative intent in an urgent or elective setting between 2016 and 2021 were eligible for inclusion in the study. Patients were divided into two groups according to whether they were operated on in low-volume or high-volume centres (defined as more than 30 cases/year).
A total of 2676 patients from 46 hospitals in 11 countries of Latin America were included, with 389 (14.5%) in the low-volume group. The median age was 67.37 years. The high-volume group presented higher rates of laparoscopic procedures (56.8 vs. 35.7%, p < 0.001, OR 2.36), with lower conversion rates, fewer intraoperative complications and a shorter operating time. The high-volume group had a shorter length of hospital stay. The overall complication rate for the whole group was 15.9%, with a lower incidence of these events in the high-volume group (13.7 vs. 28.7%, p < 0.001, OR 0.40). Overall, anastomotic leakage, reoperation and mortality rates were 5.6%, 9.2% and 6.1%, respectively, with differences favouring high-volume centres. On multivariate analysis, low-volume group, history of cardiac disease, emergency surgery, operation performed by a general surgeon, open approach and intraoperative complications were independent predictors of major postoperative complications.
This is the first study in Latin America to show better postoperative outcomes at a regional scale when surgery for right colon cancer is performed in high-volume centres. Further studies are needed to validate these data and to identify which of the factors can explain the present results.
有关拉丁美洲结肠癌患者手术结果的证据很少。本研究的目的是根据中心容量比较拉丁美洲接受右半结肠癌手术的患者的围手术期（30 天）结果。
这是一项多机构回顾性队列研究。2016 年至 2021 年期间，在紧急或择期情况下接受根治性右半结肠癌手术的个体符合入组条件。根据患者在低容量或高容量中心（定义为每年超过 30 例）接受手术，将患者分为两组。
共纳入来自拉丁美洲 11 个国家 46 家医院的 2676 名患者，其中低容量组 389 名（14.5%）。中位年龄为 67.37 岁。高容量组腹腔镜手术比例较高（56.8%比 35.7%，p<0.001，OR 2.36），中转率较低，术中并发症较少，手术时间较短。高容量组的住院时间较短。全组总体并发症发生率为 15.9%，高容量组发生率较低（13.7%比 28.7%，p<0.001，OR 0.40）。总体而言，吻合口漏、再次手术和死亡率分别为 5.6%、9.2%和 6.1%，高容量中心的结果更有利。多变量分析显示，低容量组、心脏病史、急诊手术、普通外科医生手术、开放入路和术中并发症是术后主要并发症的独立预测因素。
这是拉丁美洲第一项表明在大容量中心进行右半结肠癌手术时具有更好的术后结果的研究。需要进一步研究来验证这些数据，并确定哪些因素可以解释目前的结果。
