Hospital caseload and the results achieved in patients with rectal cancer

Background: The aim of the study was to investigate the impact of hospital caseload on the short-term postoperative outcome of patients with rectal ca rcinoma. Methods: A multicentre study involving 75 German hospitals was carried out between January and December 1999. Some 1463 patients with rectal carcinoma were studied. Results: The hospitals were divided into three groups by annual caseload as follows: less than 20 (group 1), 20-40 (group 2) and more than 40 (group 3 ). The groups were identical in terms of age, gender, height, weight, tumou r stage, risk factors and American Society of Anesthesiologists classificat ion. Postoperative morbidity was less in hospitals with a case volume of mo re than 20 patients per year (41.7 per cent in group 2 versus 49.9 per cent in group 1). The proportion of patients undergoing abdominoperineal resect ion with a permanent stoma was less in hospitals with a case volume of more than 40 patients per year (26.4 per cent in group 3 versus 34.0 per cent i n group 2). Conclusion: A large caseload in rectal surgery results in a significant red uction in permanent stoma formation and postoperative morbidity.