Hospital volume and outcome of rectal cancer surgery in Denmark 1994-99.

Objective The association between hospital volumen and outcome of major cancer surgery is being debated at present. We analysed the outcome of rectal cancer surgery in Denmark during the period 1994–99. Methods All patients with a first-time rectal cancer were registered in a national database during the 5-year period. In this observational cohort study, the influence of hospital case volume on resectional procedure, complications, 30-day mortality and 5-year mortality was analysed. Results The register comprised 5021 patients. Surgery was performed in 27 hospitals with  30 operations per year. In a multivariate model, the risk of permanent colostomywas significantly increased in the group of low-volume hospitals. On the contrary, volume did not influence the risk of anastomotic leakage, 30-day mortality and 5-year mortality. However, a large variation in 5-year mortality was observed particularly within the low-volume group of hospitals. Conclusions In this study, only risk of having a permanent colostomyduring surgery for rectal cancer was significantly related to hospital case volume. When individual hospitals were analysed, a large variation in 5-year mortality was observed within the low-volume group of hospitals.