Defining a minimum hospital volume threshold for minimally invasive colon cancer resections.

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Citation: Surgery. 171(2):293-298, 2022 02.PMID: 34429201Institution: MedStar Washington Hospital CenterDepartment: Surgery/Colorectal SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Adenocarcinoma/su [Surgery] | *Colectomy/sn [Statistics & Numerical Data] | *Colonic Neoplasms/su [Surgery] | *Hospitals, High-Volume/st [Standards] | *Hospitals, Low-Volume/st [Standards] | *Laparoscopy/sn [Statistics & Numerical Data] | *Outcome Assessment, Health Care | Adenocarcinoma/mo [Mortality] | Adenocarcinoma/pa [Pathology] | Aged | Colectomy/ae [Adverse Effects] | Colonic Neoplasms/mo [Mortality] | Colonic Neoplasms/pa [Pathology] | Female | Hospital Mortality | Humans | Laparoscopy/ae [Adverse Effects] | Length of Stay | Lymph Node Excision | Male | Middle Aged | Neoplasm Staging | Postoperative Complications | Proportional Hazards Models | Survival Analysis | United StatesYear: 2022ISSN:
  • 0039-6060
Name of journal: SurgeryAbstract: 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.All authors: Al-Refaie WB, Bader NA, Bayasi M, Chan KS, Houlihan B, Sweeney M, Villano AM, Zeymo AOriginally published: Surgery. 2021 Aug 21Fiscal year: FY2022Fiscal year of original publication: FY2022Digital Object Identifier: Date added to catalog: 2021-11-01
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Journal Article MedStar Authors Catalog Article 34429201 Available 34429201

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.

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