Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study
Matteo Rottoli, Antonino Spinelli, Gianluca Pellino, Alice Gori, Giacomo Calini, Maria Elena Flacco, Lamberto Manzoli, Gilberto Poggioli, the COVID-CRC Study Group, Angela Romano, Angela Belvedere, Antonio Lanci Lanci, D Parlanti, Gabriele Vago, A P Pezzuto, A Canavese, Gerti Dajti, Stefano Cardelli, Caterina Catalioto, Iris S Russo, Tommaso Violante, Daniele Morezzi, Ludovica Maurino, Eleonora Filippone, Dajana Cuicchi, Paolo Bernante, Elio Jovine, Raffaele Lombardi, Michele Masetti, Chiara Cipressi, Maria Fortuna Offi, Cristina Larotonda, Silvana Bernadetta Puglisi, Augusto Barbosa, Roberto Vaiana, Paolo M Bianchi, Carlo Tonti, Claudio Codignola, Luigi Zorcolo, Angelo Restivo, Simona Deidda, Marcello E Marchetti, Luca Ippolito, Gaya Spolverato, Salvatore Pucciarelli, Francesco Marchegiani, Giacomo Ghio, Gaia Zagolin, Dajana Glavas, Monica Tomassi, Riccardo Rosati, Ugo Elmore, Lorenzo Gozzini, Riccardo Calef, Francesco Puccetti, Andrea Cossu, Andrea Vignali, Mario Morino, Marco E. Allaix, Gaspare Cannata, Erica Lombardi, Carlo Alberto Ammirati, Chiara Piceni, P Buccianti, Riccardo Balestri, Marco Puccini, Daniele Pezzati, R D'ischia, Vito F Asta, Benedetta Sargenti, Giacomo Taddei, Federica Bonari, Giulia Boni, Alessandro Ferrero, Michela Mineccia, Federica Gonella, Marco Palisi, Francesco Danese, Valeria Cherubini, Serena Perotti, Michele Carvello, Fabio Carbone, Antonio Luberto, Eleonora Calafiore, Francesca De Lucia, Matteo Sacchi, Diego Sasia, Maria Chiara Giuffrida, Edoardo Ballauri, Mathieu Cardile, Serena Armentano, Elsa Beltrami, Gabriele Preve, Barbara Vercellone, Marta Mozzon, Cristina Folliero, Chiara Lirusso, Massimo Vecchiato, Antonio Ziccarelli, Davide Gattesco
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.