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ABSTRACT BACKGROUND: Colon cancer is the third most common malignancy in Colombia, only exceeded by prostate and breast cancers. It is the second most common cancer among females and the third most common among males. The epidemiology of this disease has changed in Colombia, and its peak incidence has now surpassed that of gastric cancer. AIMS: We aimed to determine the association between hospital surgical volume and mortality in patients with colon cancer undergoing surgical resection in Colombia. METHODS: This was a national retrospective cohort study based on administrative data and included adult patients undergoing surgical resection for colon cancer who were enrolled in Colombia’s contributory health system between 2012 and 2017. We defined exposure as the hospital’s surgical volume where the colon cancer surgery was performed. We classified the patients as exposed to a high surgical volume (above the 90th percentile of the provider distribution) and a low surgical volume (under the 90th percentile). The main outcomes were 30-day and 1-year mortality. Multivariate Poisson regressions were used to identify the association between exposure and mortality rates. RESULTS: The study included 4,647 patients, of which 4,188 underwent surgery at hospitals with a colectomy volume lower than 33 per year and 459 underwent surgery at institutions with volumes equal to or higher than 33 per year. In the multivariate analysis, after adjusting for observable variables, a lower risk of 30-day mortality was found in patients who underwent surgery at high surgical volume institutions (relative risk - RR 0.57, 95% confidence interval - 95%CI 0.033-0.97). No differences were found in the one-year mortality. CONCLUSION: The high surgical volume of a hospital is associated with a 30-day mortality in colon cancer, as described in other studies, but the 1-year mortality did not show this association. Prospective studies are required to establish a causal relationship.

ABSTRACT BACKGROUND: There are no information in the literature associating the volume of gastrectomies with survival and costs for the health system in the treatment of patients with gastric cancer in Colombia. AIMS: The aim of this study was to analyze how gastrectomy for gastric cancer is associated with hospital volume, 30-day and 180-day postoperative mortality, and healthcare costs in Bogotá, Colombia. METHODS: A retrospective cohort study based on hospital data of all adult patients with gastric cancer who underwent gastrectomy between 2014 and 2016 using a paired propensity score. The surgical volume was identified as the average annual number of gastrectomies performed by the hospital. RESULTS: A total of 743 patients were included in the study. Hospital mortality at 30 and 180 days postoperatively was 36 (4.85%) and 127 (17.09%) patients, respectively. The average health care cost was USD 3,200. A total of 26 or more surgeries were determined to be the high surgical volume cutoff. Patients operated on in hospitals with a high surgical volume had lower 6-month mortality (HR 0.44; 95%CI 0.27–0.71; p=0.001), and no differences were found in health costs (mean difference 398.38; 95%CI–418.93–1,215.69; p=0.339). CONCLUSIONS: This study concluded that in Bogotá (Colombia), surgery in a high-volume hospital is associated with better 6-month survival and no additional costs to the health system.

Introducción. Existen diferencias entre la concordancia de la puntuación de Gleason en biopsias prostática y la patología final. Objetivos. Determinar la concordancia de las puntuaciones de Gleason obtenidas por biopsia de próstata y por prostatectomía radical (PR) en un hospital de IV nivel en Bogotá D.C., Colombia. Materiales y métodos. Estudio retrospectivo de pruebas diagnósticas realizado en un hospital de alta complejidad de Bogotá D.C. Fueron resisados los resultados de las PR y las biopsias prostáticas, clasificando los pacientes según D’Amico y la división por grupos realizada por patólogos. La concordancia diagnóstica se determinó mediante la estimación del coeficiente de Kappa ponderado. Resultados. Se incluyeron 180 pacientes con promedio de edad de 61 años. La exactitud diagnóstica de la puntuación de Gleason dada por biopsia fue de 52%, con supraestadificación del 34% y subestadificación del 14%. El índice Kappa ponderado entre la puntuación de Gleason de la biopsia prostática y la PR fue de 0.37 (p=0.000), y por grupos de 0.4 (p=0.000), con concordancia aceptable para la muestra. Conclusiones. La concordancia de la biopsia de próstata con la PR es baja con tendencia a la supraestadificación, lo que podría tener un impacto negativo en el manejo de los pacientes con cáncer de próstata localizado.