Abstract
IntroductionHospital centralization effect is reported to lower complications and mortality for high risk and complex surgery operations, including colorectal surgery. However, no linear relation between volume and outcome has been demonstrated. Aim of the study was to evaluate the increased surgical volume effect on early outcomes of patient undergoing laparoscopic restorative anterior rectal resection (ARR).MethodsA retrospective analysis of all consecutive patients undergoing ARR with primary anastomosis between November 2016 and December 2020 after centralization of rectal cancer cases in an academic Centre. Short-term outcomes are compared to those of patients operated in the same unit during the previous 10 years before service centralization. The primary outcome was estimated anastomotic leak rate. Mean operative time, need of conversion, postoperative use of blood transfusion, radicality, in-hospital stay, number and type of complications, readmission and reoperation rate, mortality and 1-year and stoma persistence rates were evaluated as secondary outcomes.Results86 patients were operated in the study period and outcomes compared to those of 101 patients operated during the previous ten years. Difference in volume of surgery was significant between the two periods (p 0.019) and the estimated leak rate was significantly lower in the higher volume unit (p 0.047). Mean operative time, need of conversion, postoperative use of blood transfusion and in-hospital stay (p < 0.05) were also significantly reduced in Group A.ConclusionThis study suggests that the shift toward higher volume in rectal cancer surgery is associated to decreased anastomotic leak rate. Potentiation of lower volume surgical units may yield optimal perioperative outcomes.
Highlights
Hospital centralization effect is reported to lower complications and mortality for high risk and complex surgery operations, including colorectal surgery
From January 2006 to December 2020, 203 consecutive patients diagnosed with rectal cancer scheduled for anterior rectal resection at Tor Vergata Hospital in Rome, Italy
Sixteen patients did not meet the inclusion criteria and were excluded from the analysis: five patients were affected by intestinal bowel diseases, one patient was classified at high risk for surgery (ASA 4), four patients had emergency surgery, six patients underwent a rectal resection without primary anastomosis
Summary
Hospital centralization effect is reported to lower complications and mortality for high risk and complex surgery operations, including colorectal surgery. Aim of the study was to evaluate the increased surgical volume effect on early outcomes of patient undergoing laparoscopic restorative anterior rectal resection (ARR). Short-term outcomes are compared to those of patients operated in the same unit during the previous 10 years before service centralization. Mean operative time, need of conversion, postoperative use of blood transfusion, radicality, in-hospital stay, number and type of complications, readmission and reoperation rate, mortality and 1-year and stoma persistence rates were evaluated as secondary outcomes. An increasing evidence suggests that a high surgical volume is a critical factor in improving post-operative and long-term outcomes for challenging oncological procedures such as esophagectomy, gastrectomy, pancreatectomy and hepatectomy [2,3,4,5,6,7,8]. The adoption of new techniques such as laparoscopic and robotic approach and fast-track protocols demonstrates to be safe and effective in guaranteeing equal oncological outcomes and some short-term advantages, with an eye to preserving better quality of life (QOL) [14,15,16,17,18,19,20]
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