Impact of Hospital Procedure Volume on Surgical Operation and Long-Term Outcomes in High-Risk Curatively Resected Rectal Cancer: Findings From the Intergroup 0114 Study
Prior studies have demonstrated superior outcomes after a curative surgical resection of rectal cancer at hospitals where the volume of such surgeries is high. However, because these studies often lack detailed information on tumor and treatment characteristics as well as cancer recurrence, the true...
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| Veröffentlicht in: | Journal of clinical oncology 2004-01, Vol.22 (1), p.166-174 |
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| creator | MEYERHARDT, Jeffrey A TEPPER, Joel E MACDONALD, John S BENSON, Al B FUCHS, Charles S NIEDZWIECKI, Donna HOLLIS, Donna R SCHRAG, Deborah AYANIAN, John Z O'CONNELL, Michael J WEEKS, Jane C MAYER, Robert J WILLETT, Christopher G |
| description | Prior studies have demonstrated superior outcomes after a curative surgical resection of rectal cancer at hospitals where the volume of such surgeries is high. However, because these studies often lack detailed information on tumor and treatment characteristics as well as cancer recurrence, the true nature of this relation remains uncertain.
We studied a nested cohort of 1,330 patients with stage II and stage III rectal cancer participating in a multicenter, adjuvant chemoradiotherapy trial. We analyzed differences in rates of sphincter-preserving operations, overall survival, and cancer recurrence by hospital surgical volume.
We observed a significant difference in the rates of abdominoperineal resections across tertiles of hospital procedure volume (46.3% for patients resected at low-volume, 41.3% at medium-volume, and 31.8% at high-volume hospitals; P |
| doi_str_mv | 10.1200/JCO.2004.04.172 |
| format | Article |
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We studied a nested cohort of 1,330 patients with stage II and stage III rectal cancer participating in a multicenter, adjuvant chemoradiotherapy trial. We analyzed differences in rates of sphincter-preserving operations, overall survival, and cancer recurrence by hospital surgical volume.
We observed a significant difference in the rates of abdominoperineal resections across tertiles of hospital procedure volume (46.3% for patients resected at low-volume, 41.3% at medium-volume, and 31.8% at high-volume hospitals; P <.0001), even after adjustment for tumor distance from the anal verge. However, this higher rate of sphincter-sparing operations at high-volume centers was not accompanied by any increase in recurrence rates. Hospital surgical volume did not predict overall, disease-free, recurrence-free, or local recurrence-free survival. However, among patients who did not complete the planned adjuvant chemoradiotherapy (270 patients), those who underwent surgery at low-volume hospitals had a significant increase in cancer recurrence (adjusted hazard ratio, 1.94; 95% CI, 1.01 to 3.72; P =.04 for the trend) and a nonsignificant trend toward increased overall mortality (P =.08) and local recurrence (P =.10). In contrast, no significant volume-outcome relation was noted among patients who did complete postoperative therapy.
Using prospectively recorded data, we found that hospital surgical volume had no significant effect on rectal cancer recurrence or survival when patients completed standard adjuvant therapy. Sphincter-preserving surgery was more commonly performed at high-volume centers.</description><identifier>ISSN: 0732-183X</identifier><identifier>EISSN: 1527-7755</identifier><identifier>DOI: 10.1200/JCO.2004.04.172</identifier><identifier>PMID: 14701779</identifier><language>eng</language><publisher>Baltimore, MD: American Society of Clinical Oncology</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anal Canal - surgery ; Biological and medical sciences ; Chemotherapy, Adjuvant ; Cohort Studies ; Combined Modality Therapy ; Digestive System Surgical Procedures - standards ; Digestive System Surgical Procedures - statistics & numerical data ; Disease-Free Survival ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Hospitals - statistics & numerical data ; Humans ; Male ; Medical sciences ; Middle Aged ; Neoplasm Recurrence, Local ; Prospective Studies ; Radiotherapy, Adjuvant ; Rectal Neoplasms - pathology ; Rectal Neoplasms - surgery ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus ; Treatment Outcome ; Tumors</subject><ispartof>Journal of clinical oncology, 2004-01, Vol.22 (1), p.166-174</ispartof><rights>2004 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c394t-d4e61ba52856c9ce76f94a1b235042cf10b2c547af9f716966e5b65e002560d73</citedby><cites>FETCH-LOGICAL-c394t-d4e61ba52856c9ce76f94a1b235042cf10b2c547af9f716966e5b65e002560d73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3715,4009,27902,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16078170$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14701779$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MEYERHARDT, Jeffrey A</creatorcontrib><creatorcontrib>TEPPER, Joel E</creatorcontrib><creatorcontrib>MACDONALD, John S</creatorcontrib><creatorcontrib>BENSON, Al B</creatorcontrib><creatorcontrib>FUCHS, Charles S</creatorcontrib><creatorcontrib>NIEDZWIECKI, Donna</creatorcontrib><creatorcontrib>HOLLIS, Donna R</creatorcontrib><creatorcontrib>SCHRAG, Deborah</creatorcontrib><creatorcontrib>AYANIAN, John Z</creatorcontrib><creatorcontrib>O'CONNELL, Michael J</creatorcontrib><creatorcontrib>WEEKS, Jane C</creatorcontrib><creatorcontrib>MAYER, Robert J</creatorcontrib><creatorcontrib>WILLETT, Christopher G</creatorcontrib><title>Impact of Hospital Procedure Volume on Surgical Operation and Long-Term Outcomes in High-Risk Curatively Resected Rectal Cancer: Findings From the Intergroup 0114 Study</title><title>Journal of clinical oncology</title><addtitle>J Clin Oncol</addtitle><description>Prior studies have demonstrated superior outcomes after a curative surgical resection of rectal cancer at hospitals where the volume of such surgeries is high. However, because these studies often lack detailed information on tumor and treatment characteristics as well as cancer recurrence, the true nature of this relation remains uncertain.
We studied a nested cohort of 1,330 patients with stage II and stage III rectal cancer participating in a multicenter, adjuvant chemoradiotherapy trial. We analyzed differences in rates of sphincter-preserving operations, overall survival, and cancer recurrence by hospital surgical volume.
We observed a significant difference in the rates of abdominoperineal resections across tertiles of hospital procedure volume (46.3% for patients resected at low-volume, 41.3% at medium-volume, and 31.8% at high-volume hospitals; P <.0001), even after adjustment for tumor distance from the anal verge. However, this higher rate of sphincter-sparing operations at high-volume centers was not accompanied by any increase in recurrence rates. Hospital surgical volume did not predict overall, disease-free, recurrence-free, or local recurrence-free survival. However, among patients who did not complete the planned adjuvant chemoradiotherapy (270 patients), those who underwent surgery at low-volume hospitals had a significant increase in cancer recurrence (adjusted hazard ratio, 1.94; 95% CI, 1.01 to 3.72; P =.04 for the trend) and a nonsignificant trend toward increased overall mortality (P =.08) and local recurrence (P =.10). In contrast, no significant volume-outcome relation was noted among patients who did complete postoperative therapy.
Using prospectively recorded data, we found that hospital surgical volume had no significant effect on rectal cancer recurrence or survival when patients completed standard adjuvant therapy. Sphincter-preserving surgery was more commonly performed at high-volume centers.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anal Canal - surgery</subject><subject>Biological and medical sciences</subject><subject>Chemotherapy, Adjuvant</subject><subject>Cohort Studies</subject><subject>Combined Modality Therapy</subject><subject>Digestive System Surgical Procedures - standards</subject><subject>Digestive System Surgical Procedures - statistics & numerical data</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hospitals - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local</subject><subject>Prospective Studies</subject><subject>Radiotherapy, Adjuvant</subject><subject>Rectal Neoplasms - pathology</subject><subject>Rectal Neoplasms - surgery</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><issn>0732-183X</issn><issn>1527-7755</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkU-P0zAQxS0EYrsLZ27IF7ilazv-k3BDEaVFlYp2F8TNcpxJ6yWJg52A-o32Y-JqK1UaaUb2b95I7yH0jpIlZYTcfqt2y9T5MhVV7AVaUMFUppQQL9GCqJxltMh_XaHrGB8JobzIxWt0RbkiVKlygZ42_WjshH2L1z6ObjId_h68hWYOgH_6bu4B-wHfz2HvbPrcjRDM5NKTGRq89cM-e4DQ4908Wd9DxG7Aa7c_ZHcu_sbVfIL_QnfEdxDBTtCkwZ6uVGawED7hlRsaN-wjXgXf4-kAeDNMEPbBzyMmlHJ8P83N8Q161Zouwttzv0E_Vl8eqnW23X3dVJ-3mc1LPmUNB0lrI1ghpC0tKNmW3NCa5YJwZltKamYFV6YtW0VlKSWIWgoghAlJGpXfoI_PumPwf2aIk-5dtNB1ZgA_R10QUrC84Am8fQZt8DEGaPUYXG_CUVOiT-HoFI4-haNTpXDSxvuz9Fz30Fz4cxoJ-HAGTExetyFZ5OKFk0QVVJELd0hG_3MBdOxN1yVZph-tZ0zTBMv8PwVypMI</recordid><startdate>20040101</startdate><enddate>20040101</enddate><creator>MEYERHARDT, Jeffrey A</creator><creator>TEPPER, Joel E</creator><creator>MACDONALD, John S</creator><creator>BENSON, Al B</creator><creator>FUCHS, Charles S</creator><creator>NIEDZWIECKI, Donna</creator><creator>HOLLIS, Donna R</creator><creator>SCHRAG, Deborah</creator><creator>AYANIAN, John Z</creator><creator>O'CONNELL, Michael J</creator><creator>WEEKS, Jane C</creator><creator>MAYER, Robert J</creator><creator>WILLETT, Christopher G</creator><general>American Society of Clinical Oncology</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20040101</creationdate><title>Impact of Hospital Procedure Volume on Surgical Operation and Long-Term Outcomes in High-Risk Curatively Resected Rectal Cancer: Findings From the Intergroup 0114 Study</title><author>MEYERHARDT, Jeffrey A ; TEPPER, Joel E ; MACDONALD, John S ; BENSON, Al B ; FUCHS, Charles S ; NIEDZWIECKI, Donna ; HOLLIS, Donna R ; SCHRAG, Deborah ; AYANIAN, John Z ; O'CONNELL, Michael J ; WEEKS, Jane C ; MAYER, Robert J ; WILLETT, Christopher G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c394t-d4e61ba52856c9ce76f94a1b235042cf10b2c547af9f716966e5b65e002560d73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anal Canal - surgery</topic><topic>Biological and medical sciences</topic><topic>Chemotherapy, Adjuvant</topic><topic>Cohort Studies</topic><topic>Combined Modality Therapy</topic><topic>Digestive System Surgical Procedures - standards</topic><topic>Digestive System Surgical Procedures - statistics & numerical data</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Gastroenterology. 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However, because these studies often lack detailed information on tumor and treatment characteristics as well as cancer recurrence, the true nature of this relation remains uncertain.
We studied a nested cohort of 1,330 patients with stage II and stage III rectal cancer participating in a multicenter, adjuvant chemoradiotherapy trial. We analyzed differences in rates of sphincter-preserving operations, overall survival, and cancer recurrence by hospital surgical volume.
We observed a significant difference in the rates of abdominoperineal resections across tertiles of hospital procedure volume (46.3% for patients resected at low-volume, 41.3% at medium-volume, and 31.8% at high-volume hospitals; P <.0001), even after adjustment for tumor distance from the anal verge. However, this higher rate of sphincter-sparing operations at high-volume centers was not accompanied by any increase in recurrence rates. Hospital surgical volume did not predict overall, disease-free, recurrence-free, or local recurrence-free survival. However, among patients who did not complete the planned adjuvant chemoradiotherapy (270 patients), those who underwent surgery at low-volume hospitals had a significant increase in cancer recurrence (adjusted hazard ratio, 1.94; 95% CI, 1.01 to 3.72; P =.04 for the trend) and a nonsignificant trend toward increased overall mortality (P =.08) and local recurrence (P =.10). In contrast, no significant volume-outcome relation was noted among patients who did complete postoperative therapy.
Using prospectively recorded data, we found that hospital surgical volume had no significant effect on rectal cancer recurrence or survival when patients completed standard adjuvant therapy. Sphincter-preserving surgery was more commonly performed at high-volume centers.</abstract><cop>Baltimore, MD</cop><pub>American Society of Clinical Oncology</pub><pmid>14701779</pmid><doi>10.1200/JCO.2004.04.172</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0732-183X |
| ispartof | Journal of clinical oncology, 2004-01, Vol.22 (1), p.166-174 |
| issn | 0732-183X 1527-7755 |
| language | eng |
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| source | MEDLINE; American Society of Clinical Oncology Online Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Adult Aged Aged, 80 and over Anal Canal - surgery Biological and medical sciences Chemotherapy, Adjuvant Cohort Studies Combined Modality Therapy Digestive System Surgical Procedures - standards Digestive System Surgical Procedures - statistics & numerical data Disease-Free Survival Female Gastroenterology. Liver. Pancreas. Abdomen Hospitals - statistics & numerical data Humans Male Medical sciences Middle Aged Neoplasm Recurrence, Local Prospective Studies Radiotherapy, Adjuvant Rectal Neoplasms - pathology Rectal Neoplasms - surgery Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Treatment Outcome Tumors |
| title | Impact of Hospital Procedure Volume on Surgical Operation and Long-Term Outcomes in High-Risk Curatively Resected Rectal Cancer: Findings From the Intergroup 0114 Study |
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