Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Examining the transferability of colon and rectal operative experience on outcomes following laparoscopic rectal surgery



Laparoscopic rectal surgery is technically challenging and often low volume. Alternatively, colon resections utilize similar advanced laparoscopic skills and are more common but it is unknown whether this experience affects laparoscopic rectal surgery outcomes. The purpose of this paper is to determine the volume–outcome relationship between several colorectal procedures and laparoscopic rectal surgery outcomes.


This was a population-based retrospective cohort of all colorectal surgeries with primary anastomoses performed across Canada (excluding Quebec) between April 2008 and March 2015. Patient characteristics, comorbidities, procedures, and discharge details were collected from the Canadian Institute for Health Information. Volumes for common colorectal procedures were calculated for individual surgeons. All-cause morbidity, defined as complications arising during the index admission and contributing to an increased length of stay by more than 24 h, was the primary outcome examined.


A total of 5323 laparoscopic rectal surgery cases and 108,034 colorectal cases, between 180 hospitals and 620 surgeons, were identified. Data analysis demonstrated that high-volume laparoscopic rectal surgeons (OR 0.77, CI 0.61–0.96, p = 0.020) and high-volume open rectal surgeons (OR 0.76, CI 0.61–0.93, p = 0.009) significantly reduced all-cause morbidity. Conversely, surgeon volumes for laparoscopic and open colon cases had no effect on laparoscopic rectal outcomes.


High-volume surgeon status in laparoscopic and open rectal surgery are important predictors of all-cause morbidity after laparoscopic rectal surgery, while laparoscopic colon surgery volumes did not impact outcomes. This may reflect more dissimilarity between colon and rectal cases and less transferability of advanced laparoscopic skills than previously thought.

This is a preview of subscription content, log in to check access.


  1. 1.

    Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349:2117–2127

  2. 2.

    Dimick JB, Birkmeyer JD, Upchurch GR (2005) Measuring surgical quality: what’s the role of provider volume? World J Surg 29:1217–1221

  3. 3.

    Auerbach AD, Maselli J, Carter J, Pekow PS, Lindenauer PK (2010) The relationship between case volume, care quality, and outcomes of complex cancer surgery. J Am Coll Surg 211:601–608

  4. 4.

    Ogola GO, Haider A, Shafi S (2017) Hospitals with higher volumes of emergency general surgery patients achieve lower mortality rates. J Trauma Acute Care Surg 82:497–504

  5. 5.

    Begg CB, Cramer LD, Hoskins WJ, Brennan MF (1998) Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280:1747–1751

  6. 6.

    Schrag D (2000) Influence of hospital procedure volume on outcomes following surgery for colon cancer. JAMA 284:3028–3035

  7. 7.

    Hannan EL, Radzyner M, Rubin D, Dougherty J, Brennan MF (2002) The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer. Surgery 131:6–15

  8. 8.

    Parry JM, Collins S, Mathers J, Scott NA, Woodman CB (1999) Influence of volume of work on the outcome of treatment for patients with colorectal cancer. Br J Surg 86:475–481

  9. 9.

    Hermanek P, Hohenberger W (1996) The importance of volume in colorectal cancer surgery. Eur J Surg Oncol 22:213–215

  10. 10.

    Simons AJ, Ker R, Groshen S, Gee C, Anthone GJ, Ortega AE, Vukasin P, Ross RK, Beart RW (1997) Variations in treatment of rectal cancer: the influence of hospital type and caseload. Dis Colon Rectum 40:641–646

  11. 11.

    Harmon JW, Tang DG, Gordon TA, Bowman HM, Choti MA, Kaufman HS, Bender JS, Duncan MD, Magnuson TH, Lillemoe KD, Cameron JL (1999) Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. Ann Surg 230:404–413

  12. 12.

    Schrag D, Panageas KS, Riedel E, Hsieh L, Bach PB, Guillem JG, Begg CB (2003) Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection. J Surg Oncol 83:68–78

  13. 13.

    Huo YR, Phan K, Morris DL, Liauw W (2017) Systematic review and a meta-analysis of hospital and surgeon volume/outcome relationships in colorectal cancer surgery. J Gastrointest Oncol 8:534–546

  14. 14.

    Archampong D, Borowski D, Wille-Jørgensen P, Iversen LH (2012) Workload and surgeon´s specialty for outcome after colorectal cancer surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005391.pub3

  15. 15.

    Ricciardi R, Roberts PL, Read TE, Baxter NN, Marcello PW, Schoetz DJ (2011) Who performs proctectomy for rectal cancer in the United States? Dis Colon Rectum 54:1210–1215

  16. 16.

    Etzioni DA, Cannom RR, Madoff RD, Ault GT, Beart RW (2010) Colorectal procedures: what proportion is performed by American board of Colon and rectal surgery-certified surgeons? Dis Colon Rectum 53:713–720

  17. 17.

    Hyman N (2002) How much colorectal surgery do general surgeons do? J Am Coll Surg 194:37–39

  18. 18.

    Porter G, Soskolne C, Yakimets W, Newman S (1998) Surgeon-related factors and outcome in rectal cancer treatment. Int J Surg Investig 227:157–167

  19. 19.

    Wigmore SJ, Madhavan K, Currie EJ, Bartolo DC, Garden OJ (1999) Does the subspecialty of the surgeon performing primary colonic resection influence the outcome of patients with hepatic metastases referred for resection? Ann Surg 230:759–766

  20. 20.

    Prystowsky JB, Bordage G, Feinglass JM (2002) Patient outcomes for segmental colon resection according to surgeon’s training, certification, and experience. Surgery 132:663–670

  21. 21.

    Bilimoria KY, Phillips JD, Rock CE, Hayman A, Prystowsky JB, Bentrem DJ (2009) Effect of surgeon training, specialization, and experience on outcomes for cancer surgery: a systematic review of the literature. Ann Surg Oncol 16:1799–1808

  22. 22.

    Juurlink D, Preyra C, Croxford R, Chong A, Austin P, Tu J, Laupacis A (2006) Canadian institute for health information discharge abstract database: a validation study. Institute for Clinical Evaluative Sciences, Toronto

  23. 23.

    Rasbash J, Steele F, Browne WJ, Goldstein H (2019) A user’s guide to MLwiN version 3.03. Centre for multilevel modelling. University of Bristol, Bristol

  24. 24.

    Holm T, Johansson H, Cedermark B, Ekelund G, Rutqvist L-E (1997) Influence of hospital-and surgeon-related factors on outcome after treatment of rectal cancer with or without preoperative radiotherapy. Br J Surg 84:657–663

  25. 25.

    Prystowsky JB, Curet M, Rothenberger D, Joehl R, Hughes T, Gewertz B, Neumayer LA, Gaskill H, Rothhammer A, Wren S, Murayama K, Michelassi F (2005) Are young surgeons competent to perform alimentary tract surgery? Arch Surg 140:495–502

  26. 26.

    Doumouras AG, Saleh F, Anvari S, Gmora S, Anvari M, Hong D (2017) Mastery in bariatric surgery: the long-term surgeon learning curve of Roux-en-Y gastric bypass. Ann Surg 267:489–494

  27. 27.

    Simunovic M, Rempel E, Thériault M-E, Coates A, Whelan T, Holowaty E, Langer B, Levine M (2006) Influence of hospital characteristics on operative death and survival of patients after major cancer surgery in Ontario. Can J Surg 49:251–258

Download references

Author information

Correspondence to Dennis Hong.

Ethics declarations


Drs. Jennie K. Lee, Aristithes G. Doumouras, Jeremy E. Springer, Cagla Eskicioglu, Nalin Amin, Margherita Cadeddu, Dennis Hong have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 32 kb)

Supplementary material 2 (DOCX 10 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lee, J.K., Doumouras, A.G., Springer, J.E. et al. Examining the transferability of colon and rectal operative experience on outcomes following laparoscopic rectal surgery. Surg Endosc 34, 1231–1236 (2020). https://doi.org/10.1007/s00464-019-06885-w

Download citation


  • Rectal surgery
  • Laparoscopic
  • Volume