| アブストラクト | INTRODUCTION: Laparoscopic low anterior resection (L-LAR) has become widely accepted for the treatment of rectal cancer. However, little is known about the superiority of L-LAR in a real-world setting (including low-volume hospitals) and the association between the short-term outcomes and hospital volume focusing on L-LAR. METHODS: This is a retrospective cohort study. A total of 37,821 patients who underwent LAR for rectal cancer were analyzed using the Diagnosis Procedure Combination (DPC) database from January 2014 to December 2017. The short-term surgical outcomes were analyzed using a multilevel analysis. Hospital volumes were divided into quartiles, including low (1-31), middle (32-55), high (56-91), and very-high volume (92-444 resections per 4 years). The effects of hospital volume on the outcomes were investigated. RESULTS: The study population included 8,335 patients (22%) who underwent open low anterior resection (O-LAR) and 29,486 patients (78%) who underwent L-LAR. The in-hospital mortality and morbidity were consistent with previous reports. In patients who underwent L-LAR, the in-hospital mortality (0.12% vs. 0.41%; OR: 0.33; p = 0.005), the rate of reoperation (3.76% vs. 6.48%; OR: 0.67; p < 0.001), and the perioperative transfusion rate (3.81% vs. 5.90%; OR: 0.66; p < 0.001) were significantly lower in very-high-volume hospitals than in low-volume hospitals. These effects of hospital volume were not observed in O-LAR. CONCLUSIONS: Our present study demonstrates that high volume improves outcomes in patients who underwent L-LAR in a real-world setting. |
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| ジャーナル名 | Digestive surgery |
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| 投稿日 | 2023/3/23 |
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| 投稿者 | Oba, Takuya; Tomioka, Shinichi; Sato, Norihiro; Otani, Makoto; Sakurai, Akiko; Akiyama, Yasuki; Nagata, Jun; Torigoe, Takayuki; Matsuda, Shinya; Hirata, Keiji |
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| 組織名 | Department of Surgery 1, School of Medicine, University of Occupational and;Environmental Health, Kitakyusyu, Japan.;Department of Public Health and Health Policy, Graduate School of Biomedical &;Health Sciences, Hiroshima University, Hiroshima, Japan.;Occupational Health Data Science Centre, University of Occupational and;Department of Preventive Medicine and Community Health, School of Medicine,;University of Occupational and Environmental Health, Kitakyusyu, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/36948158/ |
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