Highlights
- •Rectal resection outcomes similar among high volume surgeons, despite setting.
- •Morbidity and mortality similar among high volume surgeons, despite hospital setting.
- •Overall and disease-free survival similar among high volume surgeons, despite setting.
Abstract
Background
Incomplete and flawed national databases reveal strikingly inferior outcomes for rectal
cancer patients resected at “low” versus “high “ volume hospitals, therefore, a study
of outcomes of a “high” volume surgeon in a “low” volume Midwest community hospital
setting examined this perception in comparison to contemporary studies.
Methods
Review of 109 consecutive patients who underwent open resection of rectal cancer following
neoadjuvant therapy, 1999–2010.
Results
Despite the majority of tumors in the low rectum (54%), the rate of abdominoperineal
resection was only 39% with R0 resection achieved in 94% and primary anastomosis in
61/109 patients (56%). Disease-free survival (DFS) 73%: stage 0 (complete response)-
100%, stage I- 88%, stage II- 68%, stage III- 50%, stage IV- 0% with recurrence rate
of 11% (local recurrence (LR) - 3%, distant - 8%).
Conclusion
Outcomes of rectal cancer resection by a “high” volume surgeon in a “low” volume Midwest
community hospital setting were comparable to contemporary studies from tertiary care
institutions. Geographic location and hospital capacity matter less than access to
multispecialty expertise providing neoadjuvant therapy and following standard principles
of oncologic resection, in efforts to optimize rectal cancer outcomes.
Keywords
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Article info
Publication history
Published online: September 10, 2018
Accepted:
September 3,
2018
Received in revised form:
August 31,
2018
Received:
July 9,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
