title: Influence of hospital volume on local recurrence and survival in a population sample of rectal cancer patients.
abstract: OBJECTIVE
  To investigate the role of hospital volume and individual hospitals on long term outcomes (local recurrence and survival) of rectal cancer patients.
  
  
  METHODS
  One thousand thirty-eight patients with rectal cancer were diagnosed between 1996 and 1998. From these, we analysed 884 patients with a resected invasive primary rectal cancer. Median follow-up was 5.7 years. The impact of hospital volume (<10, 10-30 and >30 rectal cancer patients annually) on local recurrence and survival was examined in a Cox model. Differences between the four largest clinics in the high volume group were also investigated.
  
  
  RESULTS
  In the multivariate model predicting survival the following variables were significant: UICC stage, grade, age, local recurrence, and (neo-) adjuvant therapy treatment. In the multivariate model predicting local recurrence UICC stage, tumour localisation, and neoadjuvant therapy treatment were significant variables. Hospital volume was not a significant factor for survival or local recurrence. Within the high volume category one hospital showed significantly worse local recurrence rates than all other hospitals, but no survival difference could be seen between the four largest hospitals of the high volume group.
  
  
  CONCLUSIONS
  This analysis of a rectal cancer population found that hospital volume did not determine survival or local recurrence. Detailed clinical data with long term follow-up from cancer registries are vital to demonstrate the quality of routine care.
authors.affiliation: Munich Cancer Registry, Munich Comprehensive Cancer Centre, Munich, Germany. engel@ibe.med.uni-muenchen.de
authors.forename: J
authors.initials: J
authors.lastname: Engel
authors.forename: J
authors.initials: J
authors.lastname: Kerr
authors.forename: R
authors.initials: R
authors.lastname: Eckel
authors.forename: B
authors.initials: B
authors.lastname: Günther
authors.forename: M
authors.initials: M
authors.lastname: Heiss
authors.forename: W
authors.initials: W
authors.lastname: Heitland
authors.forename: J R
authors.initials: JR
authors.lastname: Siewert
authors.forename: K-W
authors.initials: KW
authors.lastname: Jauch
authors.forename: D
authors.initials: D
authors.lastname: Hölzel
mesh_terms: D000368:Aged; D013505:Digestive System Surgical Procedures / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000601:surgery*; D016019:Survival Analysis