Tanaka M, et al. - The authors performed this nationwide multicenter study to explain whether hospital volume affected short- and long-term outcomes in familial adenomatous polyposis (FAP) patients. In FAP patients, hospital volume was significantly associated with short- and long-term outcomes.

• During 2000-2012, the authors established a retrospectively collected database of FAP patients who underwent initial surgical treatment at 23 Japanese institutions.
• They analyzed factors correlated with short- and long-term outcomes.

• The authors enrolled 303 FAP patients.
• They classified these patients into tertile categories according to hospital volume: low (n = 31), middle (n = 72), and high volume (n = 200).
• Among tertile categories, the proportion of only adenoma/stage 0 was comparable.
• Among tertile categories, the adoption of operative procedure significantly differed; specifically, high-volume institutions preferred handsewn ileal pouch-anal anastomosis without diverting ileostomy (P < 0.001 and < 0.001, respectively).
• Although, among tertile categories, the frequency of complications with Clavien-Dindo classification grade ≥ 3 was not significantly different.
• In every category, functional results were acceptable.
• Compared to low-volume institutions, Wexner scores were significantly lower in high-volume (P = 0.02).
• Multivariate analyses demonstrated that UICC stage and hospital volume were significantly correlated with overall survival (P = 0.04 and 0.03, respectively).