Abstract
Aims
There is a growing consensus to concentrate high-risk surgical procedures to high
volume surgeons in high volume hospitals. However, there is fierce debate about centralizing
more common malignancies such as colorectal cancer. The objective of this review is
to conduct a meta-analysis using the best evidence available on the volume-outcome
relationship for colorectal cancer treatment.
Methods
A systematic search was performed to identify all relevant articles studying the relation
between hospital and/or surgeon volume and clinical outcomes for colorectal cancer.
Using strict inclusion criteria, 23 articles were selected concerning colon cancer,
rectal cancer or both diseases together as ‘colorectal cancer’. Pooled estimated effect
sizes were calculated using the casemix adjusted outcomes of the highest volume group
opposed to the lowest volume group.
Results
High volume hospitals have a significantly lower postoperative mortality in half of
the pooled results. Non significant results show a trend in favour of high volume
hospitals. All results showed a significantly better long term survival in high volume
hospitals. High volume surgeons have a lower postoperative mortality, although evidence
is sparse. All analyses showed a significantly better long term survival in favour
of high volume surgeons.
Conclusions
The results show a clear and consistent relation between high volume providers and
improved long term survival. This applies to both high volume hospitals and high volume
surgeons. Most results show a relation between high volume providers and a reduced
postoperative mortality, but evidence is less convincing.
In the ideal world, extensive population based audit registrations with casemix adjusted
feedback should make rigid minimal volume standards obsolete. Until then, using volume
criteria for hospitals and surgeons treating colorectal cancer can improve mortality
and especially long term survival.
Keywords
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Article info
Publication history
Accepted:
June 10,
2010
Footnotes
☆Study performed by the ‘Quality of cancer care’ taskforce of the Signalling Committee Cancer of the Dutch Cancer Society (the committees full report is available on www.kwfkankerbestrijding.nl).
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
