Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study
Author:
Rottoli Matteo12ORCID, Spinelli Antonino34ORCID, Pellino Gianluca56ORCID, Gori Alice12, Calini Giacomo12, Flacco Maria E7, Manzoli Lamberto2, Poggioli Gilberto12, Romano Angela, Belvedere Angela, Lanci Antonio Lanci, Parlanti Daniele, Vago Gabriele, Pezzuto Anna Paola, Canavese Anna, Dajti Gerti, Cardelli Stefano, Catalioto Caterina, Russo Iris S, Violante Tommaso, Morezzi Daniele, Maurino Ludovica, Filippone Eleonora, Cuicchi Dajana, Bernante Paolo, Jovine Elio, Lombardi Raffaele, Masetti Michele, Cipressi Chiara, Offi Maria F, Larotonda Cristina, Puglisi Silvana B, Barbosa Augusto, Vaiana Roberto, Bianchi Paolo M, Tonti Carlo, Codignola Claudio, Zorcolo Luigi, Restivo Angelo, Deidda Simona, Marchetti Marcello E, Ippolito Luca, Spolverato Gaya, Pucciarelli Salvatore, Marchegiani Francesco, Ghio Giacomo, Zagolin Gaia, Glavas Dajana, Tomassi Monica, Rosati Riccardo, Elmore Ugo, Gozzini Lorenzo, Calef Riccardo, Puccetti Francesco, Cossu Andrea, Vignali Andrea, Morino Mario, Allaix Marco E, Cannata Gaspare, Lombardi Erica, Ammirati Carlo A, Piceni Chiara, Buccianti Piero, Balestri Riccardo, Puccini Marco, Pezzati Daniele, d'Ischia Roberto, Asta Vito F, Sargenti Benedetta, Taddei Giacomo, Bonari Federica, Boni Giulia, Ferrero Alessandro, Mineccia Michela, Gonella Federica, Palisi Marco, Danese Francesco, Cherubini Valeria, Perotti Serena, Carvello Michele, Carbone Fabio, Luberto Antonio, Calafiore Eleonora, De Lucia Francesca, Sacchi Matteo, Sasia Diego, Giuffrida Maria C, Ballauri Edoardo, Cardile Mathieu, Armentano Serena, Beltrami Elsa, Preve Gabriele, Vercellone Barbara, Mozzon Marta, Folliero Cristina, Lirusso Chiara, Vecchiato Massimo, Ziccarelli Antonio, Gattesco Davide, Moretti Luisa, Crestale Sara, Banchini Filippo, Capelli Patrizio, Romboli Andrea, Palmieri Gerardo, Conti Luigi, Rizzi Nicholas, Bonfili Deborah, de Manzini Nicolò, Germani Paola, Osenda Edoardo, Cortinovis Sara, Giunta Carlotta, Fracon Stefano, Abdallah Hussein, Bogoni Selene, Portolani Nazario, Nascimbeni Riccardo, Molfino Sarah, Tiberio Guido A M, Garosio Ilenia, Lamperti Giulia, Rigosa Diego, Ercolani Giorgio, Solaini Leonardo, Cavaliere Davide, Avanzolini Andrea, D'Acapito Fabrizio, Chiarella Leonardo L, Pietrantonio Daniela Di, Annunziata Domenico, Piccolo Roberta, Sorrentino Mario, Pansini Mauro, Cojutti Alessandro, Graziano Michele, Callegari Francesco, Balzarotti Laura, Dameno Vitale R, Cattaneo Antonio, Santolamazza Giuliano, Altieri Caterina, Magarini Riccardo, Pietrabissa Andrea, Dominioni Tommaso, Pugliese Luigi, Peri Andrea, Botti Marta, Sargenti Benedetta, Salvetti Francesco, Boni Luigi, Cassinotti Elisa, Baldari Ludovica, Messina Valentina, D'Abrosca Vera, Cianci Pasquale, Tumolo Rocco, Gattulli Domenico, Restini Enrico, Minafra Marina, Sederino Maria Grazia, Bottalico Bernardino, Pilati Pierluigi, Franzato Boris, Mattara Genny, De Simoni Ottavia, Barina Andrea, Tonello Marco, Muratore Andrea, Calabrò Marcello, Pipitone Nicoletta S Federico, Cuzzola Bruno, Van Nood Elena Herranz, Passuello Nicola, Frasson Alvise, Mammano Enzo, Faccio Luca, Vittadello Fabrizio, Bressan Alice, Sarzo Giacomo, Tamini Nicolò, Oldani Massimo, Cigagna Luca, Carissimi Francesca, De Carlo Giulia, Baccalini Edoardo, Nespoli Luca, Giordano Alessio, Cantafio Stefano, Grifoni Lucrezia, Matani Davide, Livi Serena, Delogu Daniele, Scognamillo Fabrizio, Marrosu Antonio, Guerrini Luca, Ugolini Giampaolo, Ghignone Federico, Frascaroli Giacomo, Albertini Nicola, Zattoni Davide, Taffurelli Giovanni, Montroni Isacco, Colombo Francesco, Danelli Piergiorgio, Bondurri Andrea, Maffioli Anna, Bonomi Alessandro, Pezzoli Isabella, Cammarata Francesco, Goletti Orlando, Molteni Mattia, Assisi Alberto, Quartierini Giorgio, Da Lio Corrado, Verdi Daunia, Mondi Isabella, Peluso Claudia, Macchi Lorenzo, Tanzanu Marta, Zanzi Federico, Pellegrini Sara, Andreuccetti Jacopo, D'Alessio Rossella, Pignata Giusto, De Capua Michele, Canfora Ilaria, Ottaviani Luca, Lepiane Pasquale, Balla Andrea, De Carlo Antonio, Saraceno Federica, Scaramuzzo Rosa, Guida Anna, Aguzzi Daniele, Bellora Paolo, Gentilli Sergio, Monni Manuela, Nikaj Herald, Cillara Nicola, Cannavera Alessandro, Deserra Antonello, Margiani Carla, Cabula Roberta, Dettori Manuela, Gramignano Giulia, Lezoche Giovanni, Ortenzi Monica, Orlandoni Elena S, Curzi Federica, Vitali Francesca, Capomagi Perla, Palmieri Miriam, Giuffrida Mario, Del Rio Paolo, Bonati Elena, Loderer Tommaso, Cozzani Federico, Rossini Matteo, Agnesi Stefano, Capolupo Gabriella T, Caricato Marco, Carannante Filippo, Mascianà Gianluca, Marrelli Martina, Miacci Valentina, Lauricella Sara, Tonini Valeria, Cervellera Maurizio, Pisconti Salvatore, Lozito Concetta, Shahu Juliana, Mongelli Claudia, Morelli Giulia, Sartarelli Lodovico, Sica Giuseppe S, Siragusa Leandro, Bagaglini Giulia, Guida Andrea M, Franceschilli Marzia, Bellato Vittoria, Fiorani Cristina, Taddei Antonio, Risaliti Matteo, Bartolini Ilenia, Ringressi Maria N, Tirloni Luca, Laface Letizia, Abate Emmanuele, Casati Massimiliano, Gobbi Pietro, Opocher Enrico, Mariani Nicolò M, Ceretti Andrea Pisani, Giovenzana Marco, Giuliani Beatrice, Sironi Martina, Grossi Ugo, Zanus Giacomo, Santoro Giulio Aniello, Brizzolari Marco, De Leo Eugenio, Novello Simone, Aquilino Krizia, Milardi Francesco, Olmi Stefano, Uccelli Matteo, Bonaldi Marta, Cesana Giovanni C, Bindi Marco, Galleano Raffaele, Langone Antonio, Botto Massimiliano, Franceschi Angelo, Gambino Elena, Ronconi Maurizio, Casiraghi Silvia, Casole Giovanni, Ciulla Salvatore L, Terrosu Giovanni, Calandra Sergio, Scarpa Edoardo, Cherchi Vittorio, Calini Giacomo, Martinuzzo Lisa, Clocchiatti Lucrezia, Muschitiello Davide, Romanzi Andrea, Vignati Barbara, Vannelli Alberto, Scolaro Roberta, Milanesi Maria, Rossi Fabrizio, Canonico Giuseppe, Anastasi Alessandro, Nelli Tommaso, Barlettai Marco, Fratarcangeli Riccardo, Martino Carmela Di, Damigella Andrea, Adinolfi Elvira, Birindelli Arianna, Taglietti Lucio, Dester Sara E, Fleres Francesco, Cucinotta Eugenio, Viscosi Francesca, Biondo Santino A, Badessi Giorgio, Catarsini Nivia, Mazzeo Carmelo, Rega Daniela, Delrio Paolo, Cervone Carmela, Aversano Alessia, De Franciscis Silvia, Marzo Massimiliano Di, Marra Bruno, Pace Ugo, Amato Antonio, Batistotti Paola, Mina Elisa, Serventi Alberto, Lapolla Pierfrancesco, Mingoli Andrea, Sapienza Paolo, Brachini Gioia, Cirillo Bruno, Fiori Enrico, Crocetti Daniele, Clementi Ilaria, Martines Gennaro, Picciariello Arcangelo, Tomasicchio Giovanni, Dibra Rigers, Trigiante Giuseppe, Rinaldi Marcella, Lantone Giuliano, Porcu Alberto, Perra Teresa, Scanu Antonio M, Feo Claudio F, Fancellu Alessandro, Cossu Maria L, Ginesu Giorgio C, Patriti Alberto, Coletta Diego, Petrelli Filippo, Greco Paola A, Spadoni Claudia, Cassiani Giovanna, Bianchini Federica, Arganini Marco, Bianchini Matteo, Perotti Bruno, Palmeri Matteo, Scabini Stefano, Deiana Selene, Carganico Giacomo, Pertile Davide, Soriero Domenico, Fioravanti Emanuela, Sperotto Beatrice, Nardo Bruno, Paglione Daniele, Crocco Veronica, Doni Marco, Osso Mariasara, Perri Roberto, Sampietro Gianluca M, Corbellini Carlo, Lorusso Leonardo, Manzo Carlo A, Cigognini Maria, Baldi Caterina, Palomba Giuseppe, Aprea Giovanni, Capuano Marianna, Basile Raffaele, Tutino Roberta, Massani Marco, Marinelli Laura, Canitano Nicola, Pilia Tiziana, Podda Mauro, Pisanu Adolfo, Murzi Valentina, Incani Silvia, Frongia Federica, Esposito Giuseppe, Luglio Gaetano, Tropeano Francesca P, Pagano Gianluca, Spina Eduardo, De Simone Giuseppe, Cricrì Michele, Catena Fausto, Vallicelli Carlo, Zanini Nicola, Ronconi Diana, Favi Francesco, Mazzucchelli Carlo, Convertini Girolamo, Vincenti Leonardo, Andriola Valeria, Bizzoca Cinzia, Feo Carlo V, Fabbri Nicolò, Fazzin Marta, Pesce Antonio, Gennari Silvia, Torchiaro Marco, Severi Silvia, Frontali Alice, Bracchetti Greta, Granieri Stefano, Cotsoglou Christian, Carlini Massimo, Lisi Giorgio, Spoletini Domenico, Mastrangeli Maria R, Campanelli Michela, Manigrasso Michele, Milone Marco, De Palma Giovanni D, Vertaldi Sara, Chini Alessia, Maione Francesco, Marello Alessandra, Selvaggi Francesco, Sciaudone Guido, Selvaggi Lucio, Tasselli Francesco Menegon, Fuschillo Giacomo, Oddis Lidia, Grande Simona, Grande Michele, Ascanelli Simona, Chimisso Laura, Aisoni Filippo, Rossin Eleonora, Pepe Francesco, Marchetti Francesco, Picardi Biagio, Rossi Stefano, Del Monte Simone Rossi, Picarelli Matteo, Muttillo Irnerio A, Ratto Carlo, Marra Angelo A, Parello Angelo, Litta Francesco, Campennì Paola, De Simone Veronica, Pata Francesco, Riboni Cristiana, Rausa Emanuele, Celentano Valerio,
Affiliation:
1. Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Bologna , Italy 2. Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna , Bologna , Italy 3. Department of Biomedical Sciences, Humanitas University , Milan , Italy 4. Colorectal Surgery, RCCS Humanitas Research Hospital , Milan , Italy 5. Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania Luigi Vanvitelli , Naples , Italy 6. Colorectal Surgery, University Hospital Vall d’Hebron , Barcelona , Spain 7. Department of Environmental and Preventive Sciences, University of Ferrara , Ferrara , Italy
Abstract
Abstract
Background
The association between volume, complications and pathological outcomes is still under debate regarding colorectal cancer surgery. The aim of the study was to assess the association between centre volume and severe complications, mortality, less-than-radical oncologic surgery, and indications for neoadjuvant therapy.
Methods
Retrospective analysis of 16,883 colorectal cancer cases from 80 centres (2018–2021). Outcomes: 30-day mortality; Clavien-Dindo grade >2 complications; removal of ≥ 12 lymph nodes; non-radical resection; neoadjuvant therapy. Quartiles of hospital volumes were classified as LOW, MEDIUM, HIGH, and VERY HIGH. Independent predictors, both overall and for rectal cancer, were evaluated using logistic regression including age, gender, AJCC stage and cancer site.
Results
LOW-volume centres reported a higher rate of severe postoperative complications (OR 1.50, 95% c.i. 1.15–1.096, P = 0.003). The rate of ≥ 12 lymph nodes removed in LOW-volume (OR 0.68, 95% c.i. 0.56–0.85, P < 0.001) and MEDIUM-volume (OR 0.72, 95% c.i. 0.62–0.83, P < 0.001) centres was lower than in VERY HIGH-volume centres. Of the 4676 rectal cancer patients, the rate of ≥ 12 lymph nodes removed was lower in LOW-volume than in VERY HIGH-volume centres (OR 0.57, 95% c.i. 0.41–0.80, P = 0.001). A lower rate of neoadjuvant chemoradiation was associated with HIGH (OR 0.66, 95% c.i. 0.56–0.77, P < 0.001), MEDIUM (OR 0.75, 95% c.i. 0.60–0.92, P = 0.006), and LOW (OR 0.70, 95% c.i. 0.52–0.94, P = 0.019) volume centres (vs. VERY HIGH).
Conclusion
Colorectal cancer surgery in low-volume centres is at higher risk of suboptimal management, poor postoperative outcomes, and less-than-adequate oncologic resections. Centralisation of rectal cancer cases should be taken into consideration to optimise the outcomes.
Publisher
Oxford University Press (OUP)
Cited by
1 articles.
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