title: The Influence of Hospital Volume on Circumferential Resection Margin Involvement: Results of the Dutch Surgical Colorectal Audit.
abstract: This population-based study evaluates the association between hospital volume and CRM (circumferential resection margin) involvement, adjusted for other confounders, in rectal cancer surgery. A low hospital volume (<20 cases/year) was independently associated with a higher risk of CRM involvement (odds ratio=1.54; 95% CI: 1.12-2.11).
  
  
  OBJECTIVE
  To evaluate the association between hospital volume and CRM (circumferential resection margin) involvement in rectal cancer surgery.
  
  
  BACKGROUND
  To guarantee the quality of surgical treatment of rectal cancer, the Association of Surgeons of the Netherlands has stated a minimal annual volume standard of 20 procedures per hospital. The influence of hospital volume has been examined for different outcome variables in rectal cancer surgery. Its influence on the pathological outcome (CRM) however remains unclear. As long-term outcomes are best predicted by the CRM status, this parameter is of essential importance in the debate on the justification of minimal volume standards in rectal cancer surgery.
  
  
  METHODS
  Data from the Dutch Surgical Colorectal Audit (2011-2012) were used. Hospital volume was divided into 3 groups, and baseline characteristics were described. The influence of hospital volume on CRM involvement was analyzed, in a multivariate model, between low- and high-volume hospitals, according to the minimal volume standards.
  
  
  RESULTS
  This study included 5161 patients. CRM was recorded in 86% of patients. CRM involvement was 11% in low-volume group versus 7.7% and 7.9% in the medium- and high-volume group (P≤0.001). After adjustment for relevant confounders, the influence of hospital volume on CRM involvement was still significant odds ratio (OR) = 1.54; 95% CI: 1.12-2.11).
  
  
  CONCLUSIONS
  The outcomes of this pooled analysis support minimal volume standards in rectal cancer surgery. Low hospital volume was independently associated with a higher risk of CRM involvement (OR = 1.54; 95% CI: 1.12-2.11).
authors: *Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands †Department of Surgery, Rijnland Hospital, Leiderdorp, The Netherlands ‡Department of Surgery, Deventer Hospital, Deventer, The Netherlands §Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands ¶Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands ||Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
authors: Lieke
authors: L
authors: Gietelink
authors: Daniel
authors: D
authors: Henneman
authors: Nicoline J
authors: NJ
authors: van Leersum
authors: Mirre
authors: M
authors: de Noo
authors: Eric
authors: E
authors: Manusama
authors: Pieter J
authors: PJ
authors: Tanis
authors: Rob A E M
authors: RA
authors: Tollenaar
authors: Michel W J M
authors: MW
authors: Wouters
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000592:standards*; D005260:Female; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D019984:Quality Indicators, Health Care; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology* / Q000601:surgery