Effect of Hospital Conditions on Short-Term Colorectal Cancer Outcomes: Experience of One Surgeon in Two Centers

Hastane Koşullarının Erken Dönem Kolorektal Kanser Sonuçlarına Etkisi: Tek Cerrah, İki Merkez

Abstract

Aim: Many factors can affect the outcomes of colorectal cancer (CRC) surgery. In addition to patient- and disease-related outcomes, factors such as surgeon volume and hospital conditions are thought to influence the results. However, only a few studies have compared the experience of a single surgeon from different centers. Thus, this study aimed to compare the short-term outcomes of CRC surgery performed by a single surgeon in secondary care (state hospital) and tertiary care (university/training research hospital) centers. Method: Data of patients who received treatment for colon cancer between April 2018 and January 2020 by a single surgeon, who had completed gastroenterology surgery fellowship, in two different centers were retrospectively analyzed. Patients were divided into two groups as those treated in a secondary center and a tertiary center and compared in terms of demographic characteristics, application types, cancer stage, perioperative transfusion requirement, operation conditions, durations of hospital and intensive care stay, postoperative complications, and pathology results. Results: Of the 39 patients included in the study, 13 (33.3%) were treated in a secondary state hospital and 26 (66.7%) in a tertiary training and research hospital. Moreover, 46.2% of the patients in the secondary center group and 11.5% of the patients in the tertiary center group underwent emergency surgery because of ileus. The transfusion rate was higher in the secondary center group than in the tertiary center group (76.9% vs 34.6%). The rate of laparoscopic surgery was higher in the tertiary center group than in the secondary center group (7.7% vs 69.2%). No significant difference was found between the two centers in terms of demographic characteristics, length of hospital stay, complications, and pathology results. Conclusion: Although the application rates are higher in advanced disease stages and emergency conditions, provided that the experience and training of the surgeon is sufficient, colorectal cancer surgery can be performed in relatively small and low-volume centers, with oncological results, morbidity, and mortality rates similar to those of large centers.

Özet

Amaç: Kolorektal kanser (KRK) cerrahisinin sonuçlarını etkileyen birçok faktör vardır. Hasta ve hastalık kaynaklı sonuçların yanı sıra cerrah volümü ve hastane koşulları gibi faktörlerin de sonuçlara etkisi olduğu düşünülmektedir. Ancak literatürde tek cerrahın farklı merkezlerdeki sonuçlarını karşılaştıran yeterince çalışma yoktur. Bu çalışmanın amacı tek cerrah tarafından 2. basamak (devlet hastanesi) ve 3. basamak (üniversite/eğitim araştırma hastanesi) merkezlerde yapılan KRK olgularının erken dönem sonuçlarını karşılaştırmaktır. Yöntem: Çalışmada gastroenteroloji cerrahisi yan dal eğitimi alan tek cerrah tarafından koşulları farklı iki merkezde Nisan 2018-Ocak 2020 tarihleri arasında kolon kanseri nedeniyle tedavi edilen hastalar retrospektif olarak incelendi. Hastalar 2. ve 3. basamak merkezde tedavi olanlar olarak iki gruba ayrılarak demografik özellikleri, başvuru şekilleri, kanser evresi, perioperatif transfüzyon ihtiyacı, ameliyat şartları, hastane ve yoğun bakım yatış süreleri, postoperatif komplikasyonlar ve patoloji sonuçları açısından karşılaştırıldı. Bulgular: Çalışmaya alınan 39 hastanın 13’ü (%33,3) 2. basamak devlet hastanesinde, 26’sı (%66,7) 3. basamak eğitim ve araştırma hastanesinde tedavi edildi. İkinci basamak merkezde opere edilen hastaların %46,2’si, 3. basamaktakilerin %11,5’i ileus nedeniyle acil şartlarda opere edildi.