The impact of procedure volume on outcomes following rectal cancer surgery is uncertain.
In this study, published in the November issue of Annals of Surgery, a research team compared surgeon and hospital procedure volume as predictors of outcome.
The team used the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database to identify 2815 rectal cancer patients (65 years or over).
Patients had had surgery for a primary tumor diagnosed between 1992 and 1996 in a SEER area.
|Surgeon-specific volume associated with 2-year mortality.|
|Annals of Surgery|
The team ascertained the hospital- and surgeon-specific procedure volume by the number of claims submitted during the 5-year study period.
The team set outcome measures as mortality at 30 days and 2 years, overall survival, and the rate of abdominoperineal resections.
Information on age, sex, race, comorbid illness, cancer stage, and socioeconomic status were used to adjust for differences in case mix.
The researchers found that neither hospital- nor surgeon-specific procedure volume was significantly associated with 30-day postoperative mortality, or with rates of rectal sphincter-sparing operations.
Although an association between hospital volume and mortality at 2 years was evident, this finding was no longer significant once surgeon-specific volume was controlled for.
In contrast, surgeon-specific volume was associated with 2-year mortality, and remained an important predictor even after adjustment for hospital volume.
Surgeon volume was also better than hospital procedure volume at predicting long-term survival.
Dr Deborah Schrag's team concluded, "Surgeon-specific experience as measured by procedure volume can have a significant impact on survival for patients with rectal cancer".