Outside the high-volume unit: survival in an 11-year cohort of colorectal cancer patients.
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.
Markey
G C
GC
St John's Hospital, St John's Square, Limerick, Ireland. gcmarkey@stjames.ie
Wosu
E
E
Keane
R
R
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
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