{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T15:10:06Z","timestamp":1790262606498,"version":"4.1.0"},"reference-count":64,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2010,5,26]],"date-time":"2010-05-26T00:00:00Z","timestamp":1274832000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2010,7,28]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Significant associations between caseload and surgical outcomes highlight the conflict between local cancer care and the need for centralization. This study examined the effect of hospital volume on short-term outcomes and survival, adjusting for the effect of surgeon caseload.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between 1998 and 2002, 8219 patients with colorectal cancer were identified in a regional population-based audit. Outcomes were assessed using univariable and multivariable analysis to allow case mix adjustment. Surgeons were categorized as low (26 or fewer operations annually), medium (27\u201340) or high (more than 40) volume. Hospitals were categorized as low (86 or fewer), medium (87\u2013109) or high (more than 109) volume.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Some 7411 (90\u00b72 per cent) of 8219 patients underwent surgery with an anastomotic leak rate of 2\u00b79 per cent (162 of 5581), perioperative mortality rate of 8\u00b70 per cent (591 of 7411) and 5-year survival rate of 46\u00b78 per cent. Medium- and high-volume surgeons were associated with significantly better operative mortality (odds ratio (OR) 0\u00b774, P = 0\u00b7010 and OR 0\u00b766, P = 0\u00b7002 respectively) and survival (hazard ratio (HR) 0\u00b788, P = 0\u00b7003 and HR 0\u00b793, P = 0\u00b7090 respectively) than low-volume surgeons. Rectal cancer survival was significantly better in high-volume versus low-volume hospitals (HR 0\u00b785, P = 0\u00b7036), with no difference between medium- and low-volume hospitals (HR 0\u00b796, P = 0\u00b7505).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study has confirmed the relevance of minimum volume standards for individual surgeons. Organization of services in high-volume units may improve survival in patients with rectal cancer.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bjs.7111","type":"journal-article","created":{"date-parts":[[2010,5,27]],"date-time":"2010-05-27T03:05:56Z","timestamp":1274929556000},"page":"1416-1430","source":"Crossref","is-referenced-by-count":155,"title":["Volume\u2013outcome analysis of colorectal cancer-related outcomes"],"prefix":"10.1093","volume":"97","author":[{"given":"D W","family":"Borowski","sequence":"first","affiliation":[{"name":"Department of Surgery, North Tyneside General Hospital, North Shields, UK"},{"name":"Department of Surgery, Northern Region Colorectal Cancer Audit Group, Hexham General Hospital, Hexham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D M","family":"Bradburn","sequence":"additional","affiliation":[{"name":"Department of Surgery, Wansbeck General Hospital, Ashington, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S J","family":"Mills","sequence":"additional","affiliation":[{"name":"Department of Surgery, Wansbeck General Hospital, Ashington, UK"},{"name":"Department of Surgery, Northern Region Colorectal Cancer Audit Group, Hexham General Hospital, Hexham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Bharathan","sequence":"additional","affiliation":[{"name":"Department of Surgery, North Tyneside General Hospital, North Shields, UK"},{"name":"Department of Surgery, Northern Region Colorectal Cancer Audit Group, Hexham General Hospital, Hexham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R G","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Surgery, James Cook University Hospital, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A A","family":"Ratcliffe","sequence":"additional","affiliation":[{"name":"Impact Planning and Improvement, Bill and Melinda Gates Foundation, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S B","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Surgery, North Tyneside General Hospital, North Shields, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2010,5,26]]},"reference":[{"key":"2021070910475156400_bib1","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1001\/jama.280.20.1747","article-title":"Impact of hospital volume on operative mortality for major cancer surgery","volume":"280","author":"Begg","year":"1998","journal-title":"JAMA"},{"key":"2021070910475156400_bib2","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1002\/bjs.4954","article-title":"Provider volume and outcomes for oncological procedures","volume":"92","author":"Killeen","year":"2005","journal-title":"Br J Surg"},{"key":"2021070910475156400_bib3","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1002\/bjs.5714","article-title":"A systematic review of the impact of volume of surgery and specialization on patient outcome","volume":"94","author":"Chowdhury","year":"2007","journal-title":"Br J Surg"},{"key":"2021070910475156400_bib4","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1159\/000064710","article-title":"Resection for pancreatic cancer in the new millennium","volume":"2","author":"Andr\u00e9n-Sandberg","year":"2002","journal-title":"Pancreatology"},{"key":"2021070910475156400_bib5","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1046\/j.1365-2168.2002.02135.x","article-title":"Cohort study in South and West England of the influence of specialization on the management and outcome of patients with oesophageal and gastric cancers","volume":"89","author":"Bachmann","year":"2002","journal-title":"Br J Surg"},{"key":"2021070910475156400_bib6","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1046\/j.0007-1323.2001.02015.x","article-title":"Surgical workload and outcome after resection for carcinoma of the oesophagus and cardia","volume":"89","author":"Gillison","year":"2002","journal-title":"Br J Surg"},{"key":"2021070910475156400_bib7","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1136\/bmj.327.7425.1192","article-title":"ASCOT group of surgeons; British Oesophago-Gastric Cancer Group. 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