title: Does the choice of hospital increase a chance of survival in rectal cancer?
abstract: The aim of the study was to assess the impact of hospital caseload on long-term outcomes of rectal cancer patients. We posed two questions: 1. Does the number of operations carried out in the surgical department influence five year survival and local recurrence rates? 2. Does surgery alone without adjuvant therapy performed in the particular department affect long-term results?
  
  
  METHODS
  215 consecutive rectal cancer patients treated in six hospitals of the Łódź district between 1994 and 1998 were enrolled into this prospective study. We analyzed patients in whom local excision, low anterior resection, abdominoperineal resection and Hartmann's procedure were performed. 27 percent of patients received adjuvant therapy such as radio- or chemotherapy or both. Long-term results were compared between high and low volume institutions by means of local recurrence and five year survival rates.
  
  
  RESULTS
  In high volume departments; 69.2% of five year survival rates were obtained versus 46.6% for low volume institutions (p=0.00433). Similar differences were noted comparing local recurrence rates between the aforementioned groups: 19.7% versus 36.5%, respectively (p=0.00430). In surgically treated patients who did not receive adjuvant therapy statistically significant differences were found: 76.5% of patients operated on in high volume hospitals survived five years as compared with 42.9% for low caseload institutions (p=0.00013). Local recurrence rates were 15.5% for high caseload institutions and 38.5% for low caseload hospitals (p=0.00042).
  
  
  CONCLUSIONS
  High volume hospitals achieved better results in rectal cancer patients with regard to five year survival and local recurrence rates. Better outcomes were also obtained in high caseload departments regarding surgically treated patients who did not receive adjuvant therapy.
authors: Mariusz
authors: M
authors: Pawlak
authors: Zbigniew
authors: Z
authors: Morawiec
authors: Łukasz
authors: Ł
authors: Dziki
authors: Jan
authors: J
authors: Morawiec
authors: Agnieszka
authors: A
authors: Kolacińska
authors: Adam
authors: A
authors: Dziki
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006761:Hospitals / Q000145:classification*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D011044:Poland; D011379:Prognosis; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data