Mroczkowski Paweł, Kusian Henry, Jannasch Olof, Lippert Hans, Zajdel Radosław, Zajdel Karolina, Sadowski Arkadiusz, Merecz-Sadowska Anna
Department for General and Colorectal Surgery, Medical University of Lodz, Pl. Hallera 1, 90-647 Lodz, Poland.
Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, 39120 Magdeburg, Germany.
Cancers (Basel). 2025 Jan 2;17(1):120. doi: 10.3390/cancers17010120.
: The certification of hospitals as colorectal cancer centers aims to improve treatment quality, but evidence supporting its effectiveness remains limited. This study evaluated the impact of certification on treatment outcomes for rectal cancer patients in Germany. : We conducted a retrospective analysis of 14,905 patients with primary rectal cancer (UICC Stages I-III) treated at 271 hospitals. Treatment outcomes were compared between certified colorectal cancer centers (3624 patients in 55 hospitals) and non-certified hospitals (11,281 patients in 216 hospitals). Additionally, a subset analysis examined outcomes before and after certification within the same institutions. : Certified centers demonstrated higher utilization of preoperative imaging (endorectal ultrasound: 70.7% vs. 58.2%, < 0.001; pelvic MRI: 39.1% vs. 28.5%, < 0.001) and lower rates of intraoperative complications (4.6% vs. 6.2%, < 0.001). Surgical quality indicators, including M.E.R.C.U.R.Y. classification (Grade 1: 86.5% both groups, = 0.620) and anastomotic leakage rates (11.3% vs. 11.9%, = 0.407), were comparable between certified and non-certified hospitals. Despite treating patients with more favorable tumor stages, certified centers showed no significant advantage in 5-year overall survival (82.8% vs. 82.0%, = 0.880) or 30-day mortality (2.6% both groups, = 0.869). Hospital stays were marginally shorter in certified centers (19.46 vs. 20.24 days, < 0.001). : While certification was associated with improved adherence to diagnostic protocols and reduced intraoperative complications, it did not significantly impact surgical quality or long-term survival outcomes. These findings suggest that certification alone may not guarantee superior treatment quality, as hospitals participating in quality assurance programs achieved comparable results without formal certification.
将医院认证为结直肠癌中心旨在提高治疗质量，但支持其有效性的证据仍然有限。本研究评估了认证对德国直肠癌患者治疗结果的影响。我们对在271家医院接受治疗的14905例原发性直肠癌（国际抗癌联盟I - III期）患者进行了回顾性分析。比较了认证结直肠癌中心（55家医院的3624例患者）和非认证医院（216家医院的11281例患者）的治疗结果。此外，一项亚组分析检查了同一机构认证前后的结果。认证中心术前影像学检查的使用率更高（直肠内超声：70.7%对58.2%，<0.001；盆腔MRI：39.1%对28.5%，<0.001），术中并发症发生率更低（4.6%对6.2%，<0.001）。包括M.E.R.C.U.R.Y.分类（两组均为86.5%，=0.620）和吻合口漏率（11.3%对11.9%，=0.407）在内的手术质量指标在认证医院和非认证医院之间具有可比性。尽管认证中心治疗的患者肿瘤分期更有利，但在5年总生存率（82.8%对82.0%，=0.880）或30天死亡率（两组均为2.6%，=0.869）方面没有显著优势。认证中心的住院时间略短（19.46天对20.24天，<0.001）。虽然认证与更好地遵守诊断方案和减少术中并发症相关，但它对手术质量或长期生存结果没有显著影响。这些发现表明，仅靠认证可能无法保证卓越的治疗质量，因为参与质量保证计划的医院在没有正式认证的情况下也取得了可比的结果。
