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Impact of surgeon volume on outcomes of rectal cancer surgery: A systematic review and meta-analysis

Lookup NU author(s): David Borowski, Dr Heather Dickinson

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Abstract

Aim: To clarify the relationship between surgeon caseload and patient outcomes for patients undergoing rectal cancer surgery in order to inform debate about organisation of services. Methods: We searched Medline and Embase for articles published up to March 2010, and included studies examining surgeon caseload and outcomes in rectal cancer patients treated after 1990. Outcomes considered were 30-day mortality, overall survival, anastomotic leak, local recurrence, permanent stoma and abdominoperineal excision rates. We assessed the risk of bias in included studies and performed random effects meta-analyses based on both unadjusted and casemix adjusted data. Results: Eleven included studies enrolled 18,301 rectal cancer patients undergoing resective surgery. Unadjusted meta-analysis showed a statistically significant benefit in favour of high volume surgeons for 30-day postoperative mortality (OR = 0.57, 95% CI: 0.43-0.77; based on three studies, 4809 patients) and overall survival (HR = 0.76, 95% CI 0.63-0.90; based on two studies, 1376 patients), although the former relationship was attenuated and non-significant when based on two studies (9685 patients) that adjusted for casemix (OR = 0.79, 95% CI: 0.59-1.06). Pooling of three studies (2202 patients) showed no significant relationship between surgeon volume and anastomotic leak rate. Permanent stoma formation was less likely for high volume surgeons (adjusted OR = 0.75, 95% CI: 0.64 to 0.88; based on two studies, 9685 patients) and APER rates were lower for high volume surgeons (unadjusted OR = 0.58, 95% CI: 0.45 to 0.76); based on six studies, 3921 participants. Conclusions: This review gives evidence that higher surgeon volume is associated with better overall survival, lower permanent stoma and APER rates. (C) 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Publication metadata

Author(s): Archampong D, Borowski DW, Dickinson HO

Publication type: Article

Publication status: Published

Journal: The Surgeon

Year: 2010

Volume: 8

Issue: 6

Pages: 341-352

Print publication date: 07/08/2010

ISSN (print): 1479-666X

ISSN (electronic):

Publisher: Elsevier Ltd

URL: http://dx.doi.org/10.1016/j.surge.2010.07.003

DOI: 10.1016/j.surge.2010.07.003

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