| Affiliation: | 1.Colorectal Surgery Division,National Cancer Center Hospital,Tokyo,Japan;2.Department of Surgery,National Defense Medical College,Saitama,Japan;3.Department of Surgery,Tokyo Metropolitan Hiroo Hospital,Tokyo,Japan;4.Gastroenterological Center, Department of Gastroenterological Surgery, Japanese Foundation for Cancer Research,Cancer Institute Hospital,Tokyo,Japan;5.Digestive Disease Center,Showa University Northern Yokohama Hospital,Kanagawa,Japan;6.Department of Surgery,Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital,Tokyo,Japan;7.Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences,Hiroshima University,Hiroshima,Japan;8.Department of Gastrointestinal and Pediatric Surgery,Mie University Graduate School of Medicine,Mie,Japan;9.Department of Surgery,Hyogo College of Medicine,Hyogo,Japan;10.Department of Digestive Tract and General Surgery, Saitama Medical Center,Saitama Medical University,Saitama,Japan;11.Department of Surgical Oncology, Graduate School,Tokyo Medical and Dental University,Tokyo,Japan |
| Abstract: | PurposeMany studies have shown that hospital volume is significantly associated with short- and long-term outcomes in various diseases, including cancer. However, there have been no reports discussing the relationship between hospital volume and familial adenomatous polyposis (FAP). This study aimed to clarify whether hospital volume affects short- and long-term outcomes in FAP patients.MethodsWe established a retrospectively collected database of FAP patients who underwent initial surgical treatment at 23 Japanese institutions during 2000–2012. Factors associated with short- and long-term outcomes were analyzed.ResultsThe study cohort included 303 FAP patients. These patients were classified into tertile categories according to hospital volume: low (n = 31), middle (n = 72), and high volume (n = 200). The proportion of only adenoma/stage 0 was comparable among tertile categories. The adoption of operative procedure significantly differed among tertile categories; specifically, high-volume institutions preferred handsewn ileal pouch-anal anastomosis without diverting ileostomy (P < 0.001 and < 0.001, respectively). Nevertheless, the frequency of complications with Clavien-Dindo classification grade ≥ 3 was not significantly different among tertile categories. Functional results were acceptable in every category. Wexner scores were significantly lower in high-volume compared to low-volume institutions (P = 0.02). Multivariate analyses showed that UICC stage and hospital volume were significantly associated with overall survival (P = 0.04 and 0.03, respectively).ConclusionsHospital volume was significantly associated with short- and long-term outcomes in FAP patients. |
