title: Outside the high-volume unit: survival in an 11-year cohort of colorectal cancer patients.
abstract: BACKGROUND
  The policy of redistributing surgical case volume toward designated high-volume hospitals to improve outcome in cancer is supported by an international literature on volume-outcome association.
  
  
  METHODS
  All patients who underwent surgery for colorectal carcinoma under the care of one surgeon at a non-high-volume hospital 1995-2005 were identified. 5-year overall survival probability and 30-day operative mortality were measured.
  
  
  RESULTS
  Two hundred and forty patients were identified. Mean annual surgeon caseload was 21.6 (SD 4.2). 5-year overall survival probability was 57.1% (95% confidence interval ±7.4%). 30-day operative mortality was 4.6%.
  
  
  CONCLUSIONS
  Estimates of outcome were not different from publically available values from a high-volume unit in Ireland. These findings suggest that concentrating case volume per se may not improve outcome to the extent desired. Future improvement in colorectal cancer outcome is just as likely to derive from wider screening, better surgical training, and adequately powered clinical research, should these accompany centralisation.
authors.affiliation: St John's Hospital, St John's Square, Limerick, Ireland. gcmarkey@stjames.ie
authors.forename: G C
authors.initials: GC
authors.lastname: Markey
authors.forename: E
authors.initials: E
authors.lastname: Wosu
authors.forename: R
authors.initials: R
authors.lastname: Keane
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods; D015179:Colorectal Neoplasms / Q000401:mortality*; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care
references.citation: JAMA. 2000 Mar 1;283(9):1159-66
references.pmid: 10703778
references.citation: N Engl J Med. 1979 Dec 20;301(25):1364-9
references.pmid: 503167
references.citation: Ann Thorac Surg. 2003 Mar;75(3):1048-58
references.pmid: 12645752
references.citation: JAMA. 2000 Dec 20;284(23):3028-35
references.pmid: 11122590
references.citation: N Engl J Med. 2002 Apr 11;346(15):1128-37
references.pmid: 11948273