TY  - BOOK
AU  - Bayasi, Mohammed
TI  - Defining a minimum hospital volume threshold for minimally invasive colon cancer resections
SN  - 0039-6060
PY  - 2022///
KW  - *Adenocarcinoma/su [Surgery]
KW  - *Colectomy/sn [Statistics & Numerical Data]
KW  - *Colonic Neoplasms/su [Surgery]
KW  - *Hospitals, High-Volume/st [Standards]
KW  - *Hospitals, Low-Volume/st [Standards]
KW  - *Laparoscopy/sn [Statistics & Numerical Data]
KW  - *Outcome Assessment, Health Care
KW  - Adenocarcinoma/mo [Mortality]
KW  - Adenocarcinoma/pa [Pathology]
KW  - Aged
KW  - Colectomy/ae [Adverse Effects]
KW  - Colonic Neoplasms/mo [Mortality]
KW  - Colonic Neoplasms/pa [Pathology]
KW  - Female
KW  - Hospital Mortality
KW  - Humans
KW  - Laparoscopy/ae [Adverse Effects]
KW  - Length of Stay
KW  - Lymph Node Excision
KW  - Male
KW  - Middle Aged
KW  - Neoplasm Staging
KW  - Postoperative Complications
KW  - Proportional Hazards Models
KW  - Survival Analysis
KW  - United States
KW  - MedStar Washington Hospital Center
KW  - Surgery/Colorectal Surgery
KW  - Journal Article
N2  - BACKGROUND: Laparoscopic colectomy is considered the standard of care in colon cancer treatment when appropriate expertise is available. However, guidelines do not delineate what experience is required to implement this approach safely and effectively. This study aimed to establish a data-derived, hospital-level annual volume threshold for laparoscopic colectomy at which patient outcomes are optimized; CONCLUSION: A high-volume hospital threshold of >=30 cases/year for laparoscopic colectomies is associated with improved patient survival and outcomes. A minimum volume standard may help providers determine which approach is most suitable for their hospital's practice as open procedures may yield better oncologic results in low volume settings. Copyright (c) 2021. Published by Elsevier Inc; METHODS: This evaluation included 44,157 stage I to III adenocarcinoma patients aged >=40 years who underwent laparoscopic colon resection between 2010 and 2015 within the National Cancer Database. The primary outcome was overall survival, with 30- and 90-day mortality, duration of stay, days to receipt of chemotherapy, and number of lymph nodes examined as secondary. Segmented logistic and Cox regression models were used to identify volume thresholds which optimized these outcomes; RESULTS: In hospitals performing >=30 laparoscopic colectomies per year there were incremental improvements in overall survival for each additional resection beyond 30. Hospitals performing >=30 procedures/year demonstrated improved 30-day mortality (1.3% vs 1.7%, P < .001), 90-day mortality (2.3% vs 2.9%, P < .001), and overall survival (84.3% vs 82.3%, P < .001). Those hospitals performing <30 procedures/year had no significant benefit in overall survival. Thresholds were not identified for any other outcomes. Results were comparable in colon cancer patients with stage IV or multiple cancers
UR  - https://dx.doi.org/10.1016/j.surg.2021.06.031
ER  -