Het volume van chirurgische ingrepen en de impact ervan op ... - KCE

KCE Reports 113 Volume Outcome 97
VOLUME OUTCOME ASSOCIATION
The present study found no association between hospital volume and 2-year mortality.
Two-year mortality was unexpectedly low in very low volume centres (23.9% in very
low volume centres (1-10/year compared to average of 28.2), but these are also the
centres with the highest percentage of missing stage data (40% compared to average
26%), This result contrasts with the findings from the literature review which concluded
that there is evidence for an inverse relationship between hospital volume and mortality
for colon cancer surgery.
A possible explanation for the fact that low-volume hospitals have such low mortality
could be that these patients were treated by high-volume surgeons. This hypothesis was
tested, however, and rejected since Figure 5.21 showed that patients at low-volume
hospitals were mainly operated on by low-volume surgeons.
With respect to surgeon volume, the study suggests an inverse association with 2-year
mortality, although it did not reach statistical significance. Two-year mortality decreased
from 30.8% for small volume surgeons (20/year). As other authors pointed out, this effect may also result from the skill of the
individual surgeon. Porter et al. found that cancer-specific survival is improved with both
colorectal surgical subspecialty training and a higher frequency of rectal cancer surgery.
Therefore, they recommend that the surgical treatment of rectal cancer patients should
rely exclusively on surgeons with such training or surgeons with more experience. 218
McArdle and colleagues go even further when they support that surgical specialization is
the primary determinant of outcome for colorectal cancer. 201