Does the Choice of Hospital Increase a Chance of Survival in Rectal Cancer?

• Authors: Mariusz Pawlak , Zbigniew Morawiec , Łukasz Dziki , Jan Morawiec , Agnieszka Kolacińska , Adam Dziki
• Languages of publication: EN

Abstracts

EN

was to assess the impact of hospital caseload on long-term outcomes of rectal cancer patients. We posed two questions: 1. Does the number of operations carried out in the surgical department influence five year survival and local recurrence rates? 2. Does surgery alone without adjuvant therapy performed in the particular department affect long-term results?Material and methods. 215 consecutive rectal cancer patients treated in six hospitals of the Łódź district between 1994 and 1998 were enrolled into this prospective study. We analyzed patients in whom local excision, low anterior resection, abdominoperineal resection and Hartmann’s procedure were performed. 27 percent of patients received adjuvant therapy such as radio- or chemotherapy or both. Long-term results were compared between high and low volume institutions by means of local recurrence and five year survival rates.Results. In high volume departments; 69.2% of five year survival rates were obtained versus 46.6% for low volume institutions (p=0.00433). Similar differences were noted comparing local recurrence rates between the aforementioned groups: 19.7% versus 36.5%, respectively (p=0.00430). In surgically treated patients who did not receive adjuvant therapy statistically significant differences were found: 76.5% of patients operated on in high volume hospitals survived five years as compared with 42.9% for low caseload institutions (p=0.00013). Local recurrence rates were 15.5% for high caseload institutions and 38.5% for low caseload hospitals (p=0.00042).Conclusions. High volume hospitals achieved better results in rectal cancer patients with regard to five year survival and local recurrence rates. Better outcomes were also obtained in high caseload departments regarding surgically treated patients who did not receive adjuvant therapy.

Keywords

EN

rectal cancer   prognostic factors   hospital caseload   5-year survival   local recurrence  

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2012
• Volume: 84
• Issue: 12
• Pages: 638-645

Dates

published

1 - 12 - 2012

online

09 - 02 - 2013

References

• 1. Ciccolallo L, Capocaccia R, Coleman MP: Survival differences between European and US patients with colorectal cancer: role of stage at diagnosis and surgery. Gut 2005; 54(2): 268-73.[Crossref][PubMed]
• 2. Zatoński WA: Malignant neoplasms in Poland (in Polish). W.A.Zatoński, 2006; 25-27.
• 3. Dziki A, Sygut R, Zajdel R et al.: Delayed diagnosis and treatment of colorectal cancer of patients with colostomy. Nowotwory 2000; 50 (supl. 3): 38.
• 4. Ułańska J, Dziki A, Langner E, Wroński W: Risk factors in the recurrence of the colorectalcancer. Acta Chir Jugosl 2002; 49(2): 41-43.
• 5. Howard JH, Gonzalez Q, Arnoletti JP: Prognostic factors and preoperative radiation therapy associated with sphincter preservation in patients with resectable rectal cancer. Am J Surg 2008; 195(2): 239-43.
• 6. Jatzko GR, Jogoditsch M, Lizborg PH et al.: Long - term results of radical surgery for rectal cancer: multivariate analisis of prognostic factors influencing survival and local recurrence. Eur J SurgOncol 1999; 25: 284-91.
• 7. Kapiteijn E et al.: Local recurrence in patients with rectal cancer diagnosed between 1988 - 1992: a population - based study in the west Netherlands. Eur J Surg Oncol 1998; 24: 528-35.
• 8. Wiig JN, Larsen SG, Dueland S: Preoperative irradiation and surgery for local recurrence of rectal and rectosigmoid cancer. Prognostic factors with regard to survival and further local recurrence. Colorectal Dis 2008; 10(1): 48-57.[WoS][PubMed]
• 9. Porter GA, Soskolne CL , Yakimets WW, NewmanSC: Surgeon - related factors and outcome in Rectal Cancer. Ann Surg 1998; 227 (2); 157-67.
• 10. Dahlberg M, Glimelius B, Pahlman L: Changing strategy for rectal cancer is associated with improved outcome. Br J Surg 1999; 86: 379-84.
• 11. Glynne-Jones R, Mawdsley S, Novell JR: The clinical significance of the circumferential resection margin following preoperative pelvic chemoradiotherapy in rectal cancer: why we need a common language. Colorectal Dis 2006; 8(9): 800-07.[Crossref]
• 12. Heald RJ, Moran BJ, Ryall RDH et al.: The Basingstoke experience of total mesorectal excision. Arch Surg 1998; 133: 894-99.
• 13. Holm T, Johansson H, Cedemark B et al.: Influence of hospital - and surgeon - related factors on outcome after treatment of rectal cancer with or without preoperative radiotherapy. Br J Surg 1997; 84: 657-63.
• 14. Frileux P, Burdy G, Aegerter P: Surgical treatment of rectal cancer: results of a strategy for selective preoperative radiotherapy. GastroenterolClin Biol 2007; 31(11): 934-40.[Crossref]
• 15. Killingback M, Barron P, Owen F: Local recurrence after curative resection of cancer of the rectum without total mesorectal excision. Dis ColonRectum 2001; 44: 473-86.
• 16. Morschel M, Heintz A, JungingerT: Prognostic factors in local recurrence rate after surgical therapy of rectal carcinomas. Zentralbl Chir 1996; 121: 177-83.
• 17. Hermanek P: Impact of surgeon’s technique on outcome after treatment of rectal carcinoma. DisColon Rectum 1999; 42: 559-62.[Crossref]
• 18. Simons AJ et al.: Variations in treatment of rectal cancer. The influence of hospital type and caseload. Dis Colon Rectum 1997; 40: 641-45.[Crossref][PubMed]
• 19. Porter GA: Authors’ Reply to Letters to the Editor. Comments to: Surgeon-related factors and outcome in rectal cancer. Ann Surg 1999; 229: 443.
• 20. Kapiteijn E, Marijnen CA, Nagtegaal ID: Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N EnglJ Med 2001; 345: 638-46.
• 21. Lehnert T: Combined treatment of rectal cancer. Proktologia 2002; supl. 1: 42-44.
• 22. Heriot AG, Kumar D: Adjuvant therapy for resectable rectal and colonic cancer. Br J Surg 1998; 85: 300-09.
• 23. Dowdall JF, Maguire D, McAnena OJ: Experience of surgery for rectal cancer with total mesorectal excision in a general surgical practice. Br JSurg 2002; 89 (8): 946-47.
• 24. Di Cataldo A, Scilletta B, Latino R: The surgeon as a prognostic factor in the surgical treatment of rectal cancer. Surg Oncol 2007; 16 Suppl 1: S53-56.[Crossref]
• 25. Schrag D, Panageas KS, Riedel E et al.: Hospital and surgeon procedure volume as predictors of outcome following rectal cancer resection. Ann Surg 2002; 236 (5): 583-92.
• 26. Simunovic M et al.: Hospital procedure volume and teaching status do not influence treatment and outcome measures of rectal cancer surgery in a large general population. J Gastrointest Surg 2000; 4(3): 324-30.[Crossref]
• 27. Cedermark B, Johansson H, Rutqvist LE , WilkingN: Stockholm Colorectal Cancer Study Group. The Stockholm I trial of preoperative short term radiotherapy in operable rectal carcinoma. A prospective randomized trial. Cancer 1995; 75: 2269-75.
• 28. Lehander Martling A, Holm T, Rutqvist LE et al.: Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Lancet 2000; 356: 93-97.
• 29. Penninckx F: Surgeon - related aspects of the treatment and outcome after radical resection for rectal cancer. Acta Gastroenterol Belg 2001; 64(3): 258-62.[PubMed]
• 30. Ko CY, Chang JT, Chaudhry S, Kominski G: Are high-volume surgeons and hospitals the most important predictors of in-hospital outcome for colon cancer resection? Surgery 2002; 132: 268-73.
• 31. Hermanek P. Jr, Wiebelt H, Riedl S et al.: und die Studiengruppe Kolorektales Karzinom (SGKRK). Langzeitergebnisse der chirurgischen Therapie des Coloncarcinoms. Ergebnise der Studiengruppe Kolorektales Karzinom (SGKRK). Chirurg 1994; 65: 287-97.

Identifiers

DOI

10.2478/v10035-012-0105-1