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The Impact of Hospital Volume on Surgical Outcome in Patients with Rectal Cancer
Ersta Hospital.
Malmo University Hospital.
Karolinska Institute.
Sunderby Hospital.
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2009 (English)In: DISEASES OF THE COLON and RECTUM, ISSN 0012-3706, Vol. 52, no 9, 1542-1549 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: This study was designed to investigate, in a population-based setting, the surgical outcome in patients with rectal cancer according to the hospital volume. METHODS: Since 1995 all patients with rectal cancer have been registered in the Swedish Rectal Cancer Registry. Hospitals were classified, according to number treated per year, as low-volume, intermediate-volume, or high-volume hospitals (andlt; 11, 11-25, or andgt;25 procedures per year). Postoperative mortality, reoperation rate within 30 days, local recurrence rate, and overall five-year survival were studied. For postoperative morbidity and mortality the whole cohort from 1995 to 2003 (n = 10,425) was used. For cancer-related outcome only, those with five-year follow-ups, from 1995 to 1998, were used (n = 4,355). RESULTS: In this registry setting the postoperative mortality rate was 3.6% in low-volume hospitals, and 2.2% in intermediate- volume and high-volume hospitals (P = 0.002). The reoperation rate was 10%, with no differences according to volume. The overall local recurrence rates were 9.4%, 9.3%, and 7.5%, respectively (P = 0.06). Significant difference was found among the nonirradiated patients (P = 0.004), but not among the irradiated patients (P = 0.45). No differences were found according to volume in the absolute five-year survival. CONCLUSION: Postoperative mortality and local recurrence in nonirradiated patients were lower in high-volume hospitals. No difference was seen between volumes in reoperation rates, overall local recurrence, or absolute five-year survival.

Place, publisher, year, edition, pages
2009. Vol. 52, no 9, 1542-1549 p.
Keyword [en]
Rectal cancer, Hospital volume, Caseload, Outcome, Local recurrence, Survival
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-53692DOI: 10.1007/DCR.0b013e3181af58f4OAI: diva2:291261
Available from: 2010-02-01 Created: 2010-02-01 Last updated: 2010-02-01

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Sjödahl, Rune
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Surgery Faculty of Health SciencesDepartment of Surgery in Östergötland
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