Impact of hospital volume on survival in patients with locally advanced colon cancer - A Dutch population-based study.

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-02-01 DOI:10.1111/codi.17288

L C F de Nes, P J Tanis, R H Verhoeven, J H W de Wilt, P A J Vissers

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Abstract

Aim: Locally advanced colon cancer (LACC) often necessitates complex prognosis-determining treatment. This study investigated the impact of hospital volume on short- and long-term outcomes following surgery for LACC.

Method: Data involving all patients with LACC categorized as clinical T4 and/or N2, between 2015 and 2019 in the Netherlands, were extracted from the Netherlands Cancer Registry. Hospitals were stratified into low volume (1-19 LACC resections per year), medium volume (20-29 LACC resections per year) and high volume (≥30 LACC resections per year). Data were analysed using Kaplan-Meier curves, logistic regression analysis and Cox-regression models.

Results: A total of 49 298 patients were diagnosed with colon cancer, of whom 9206 (18.7%) had locally advanced disease. Of these 9206 patients, resection was performed in 8537 with a median age of 71 (interquartile range: 63-78) years. Patients were more likely to undergo laparoscopic procedures in high-volume hospitals than in low-volume hospitals (OR = 1.28, 95% CI: 1.12-1.46). No risk differences in anastomotic leakage or postoperative 90-day mortality were observed according to hospital volume. Five-year overall survival rates were comparable among high-, medium- and low-volume hospitals (58.7% vs. 58.0% vs. 60.0%, p = 0.62). Hospital volume was not associated with overall survival in multivariable analysis. Independent predictors of worse overall survival included older age, higher American Society of Anaesthesiologists score, emergency/urgent setting, anastomotic leakage, higher pTNM status, involved resection margins and no adjuvant chemotherapy.

Conclusion: Despite the complexity of surgical treatment, hospital volume was not associated with survival in LACC. Hospital volume might be an imperfect surrogate for quality assessment.

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目的：局部晚期结肠癌（LACC）通常需要进行复杂的预后决定性治疗。本研究调查了医院规模对 LACC 手术后短期和长期预后的影响：从荷兰癌症登记处提取了2015年至2019年期间荷兰所有临床分类为T4和/或N2的LACC患者的数据。医院被分为低量（每年1-19例LACC切除术）、中量（每年20-29例LACC切除术）和高量（每年≥30例LACC切除术）。数据采用卡普兰-梅耶曲线、逻辑回归分析和 Cox 回归模型进行分析：共有 49 298 例结肠癌患者被确诊，其中 9206 例（18.7%）为局部晚期。在这9206名患者中，有8537人接受了切除手术，中位年龄为71岁（四分位间范围：63-78岁）。与低流量医院相比，高流量医院的患者更有可能接受腹腔镜手术（OR = 1.28，95% CI：1.12-1.46）。根据医院规模的不同，吻合口漏或术后90天死亡率没有风险差异。高、中、低医院的五年总生存率相当（58.7% vs. 58.0% vs. 60.0%，P = 0.62）。在多变量分析中，医院规模与总生存率无关。总生存率较差的独立预测因素包括年龄较大、美国麻醉医师协会评分较高、急诊/急诊环境、吻合口漏、pTNM状态较高、切除边缘受累以及未进行辅助化疗：尽管手术治疗很复杂，但住院量与 LACC 患者的生存率无关。住院量可能是质量评估的一个不完美替代指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.