Rectal cancer surgery: volume-outcome analysis

Purpose There is strong evidence supporting the importance of the volume-outcome relationship with respect to lung and pancreatic cancers This relationship for rectal cancer surgery however remains unclear We review the currently available literature to assess the evidence base for volume outcome in relation to rectal cancer surgery Methods We analysed the Medline "PubMed" online database using the keyword search parameters of "rectal cancer", "hospital volume or caseload", "surgeon volume or caseload", "outcomes", "mortality", 'approach", "local recurrence" and "morbidity" for the time period 1997-2009 Five hundred twenty-six generic articles were identified Articles that were not specific for, or separately identified, rectal cancer surgery in their individual analysis were excluded Eighteen articles remained for review We assessed short-term morbidity and long-term outcomes such as sphincter preservation, mortality and local recurrence rates Results Considerable variance was noted in the definition of high volume and low volume Postoperative length of stay was lower and sphincter-preserving surgery was more commonly performed in high-volume hospitals and by high-volume surgeons Surgeon specialisation was an important factor influencing sphincter preservation, survival and local recurrence rates Volume was found to have no negative relationship with mortality and a positive one with local recurrence Interestingly, there was no association found between hospital or surgeon caseload and postoperative morbidity Conclusion There is a paucity of evidence in the literature regarding the volume outcome relationship with regard to rectal cancer surgery High-volume institutions yielded shorter lengths of stay However, the key finding was that high-volume surgeons that specialised in colorectal surgery yielded objectively improved outcomes for patients with rectal cancer