Background

Prior studies assessing colorectal cancer survival have reported better outcomes when operations are performed at high-volume centers. These studies have largely been cross-sectional, making it difficult to interpret their estimates. We aimed to assess the effect of facility volume on survival following proctectomy for rectal cancer.

Methods

Using data from the National Cancer Database, we included all patients with complete baseline information who underwent proctectomy for non-metastatic rectal cancer between 2004 and 2016. Facility volume was defined as the number of rectal cancer cases managed at the treating center in the calendar year prior to the patient’s surgery. Overall survival estimates were obtained for facility volumes ranging from 10 to 100 cases/year. Follow-up began on the day of surgery and continued until loss to follow-up or death.

Results

A total of 52,822 patients were eligible. Patients operated on at hospitals with volumes of 10, 30, and 50 cases/year had similar distributions of grade, clinical stage, and neoadjuvant therapies. 1-, 3-, and 5-year survival all improved with increasing facility volume. One-year survival was 94.0% (95% CI: 93.7, 94.3) for hospitals that performed 10 cases/year, 94.5% (95% CI: 94.2, 94.7) for 30 cases/year, and 94.8% (95% CI: 94.5, 95.0) for 50 cases/year. Five-year survival was 68.9% (95% CI: 68.0, 69.7) for hospitals that performed 10 cases/year, 70.8% (95% CI: 70.1, 71.5) for 30 cases/year, and 72.0% (95% CI: 71.2, 72.8) for 50 cases/year.

Conclusions

Treatment at a higher volume facility results in improved survival following proctectomy for rectal cancer, though the small benefits are less profound than previously reported.

中文翻译：

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设施容量对直肠癌直肠切除术后生存率的影响

背景

先前评估结直肠癌生存率的研究报告说，当在高容量中心进行手术时，结果会更好。这些研究在很大程度上是横断面的，因此很难解释他们的估计。我们旨在评估设施容量对直肠癌直肠切除术后生存率的影响。

方法

使用来自国家癌症数据库的数据，我们纳入了 2004 年至 2016 年期间因非转移性直肠癌接受直肠切除术的所有具有完整基线信息的患者。设施容量定义为日历年治疗中心管理的直肠癌病例数在患者手术前。获得了从 10 到 100 例/年的设施容量的总体生存率估计值。随访从手术当天开始，一直持续到失访或死亡。

结果

共有 52,822 名患者符合条件。在每年 10、30 和 50 例病例的医院接受手术的患者在分级、临床分期和新辅助治疗方面的分布相似。1 年、3 年和 5 年生存率都随着设施数量的增加而提高。每年执行 10 例病例的医院的一年生存率为 94.0%（95% CI：93.7, 94.3），每年执行 30 例病例的医院为 94.5%（95% CI：94.2, 94.7）和 94.8%（95% CI： 94.5, 95.0) 50 例/年。每年进行 10 例病例的医院的 5 年生存率为 68.9%（95% CI：68.0, 69.7），每年进行 30 例病例的医院为 70.8%（95% CI：70.1, 71.5）和 72.0%（95% CI： 71.2, 72.8) 50 例/年。

结论

在更大容量的设施中进行治疗可以提高直肠癌直肠切除术后的生存率，尽管其小的益处不如以前报道的那么显着。