Effect of hospital volume on postoperative mortality and survival after oesophageal and gastric cancer surgery in the Netherlands between 1989 and 2009

305 Background: There is a known volume-outcome association for complex surgial procedures such as oncologic gastric resections. The aim of this study was to describe the process of centralization for gastric cancer surgery in the Netherlands in relation to other types of upper gastrointestinal (GI) cancer resections and to investigate whether the quality of gastric cancer surgery is affected by the overall experience with those related complex surgical procedures. Methods: Data on all patients (n = 4251) who underwent surgical treatment for non metastatic invasive gastric cancer between 2005-2013 were obtained from the Netherlands Cancer Registry. Annual hospital volume categories were based on the overall volume of gastrectomies, esophagectomies and pancreatectomies together (composite hospital volume). Volume-outcome analyses were performed for lymph node yield, 30-day mortality, and overall survival. Results: The percentage of gastric cancer patients who underwent a resection in a hospital with a volume of at least 20 gastrectomies per year increased. At the same time, the percentage of gastric cancer patients who underwent surgery in hospitals with an annual composite hospital volume of at least 20 upper GI cancer resections, such as esophageal and pancreatic cancer resections, increased. A higher composite hospital volume was associated with a higher lymph node yield, a lower 30-day mortality, and an increased overall survival. Conclusions: In the Netherlands, an increasing proportion of gastric cancer resections is performed in hospitals that are high volume centers for esophagectomies and pancreatectomies for cancer. Experience with these complex surgical procedures has a favorable effect on the outcomes of gastric cancer surgery.

Download Full-text

Positive association of gastric cancer surgery outcome with surgeon specialization in a Shanghai high-volume general hospital.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.4092 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 4092-4092

Author(s):

Zhenbin Shen ◽

Yihong Sun ◽

Cong Wang ◽

Naiqing Zhao ◽

Weidong Chen ◽

...

Keyword(s):

Gastric Cancer ◽

General Hospital ◽

Surgical Training ◽

Statistical Significance ◽

Postoperative Mortality ◽

High Volume ◽

Cancer Surgery ◽

Specialty Training ◽

Gastric Cancer Surgery ◽

High Volume Hospital

4092 Background: Numerous studies suggest positive relationship between hospital volume and cancer treatment outcomes, the surgeon’s experience and specialty training may also be important. This was examined in a high volume hospital in Shanghai among patients who underwent gastric cancer (GC) surgery. Methods: Data on consecutive patients (pts) undergoing R0 or R1 GC resection in Zhongshan hospital between January 2003 and June 2010 were collected and analyzed. Follow-up on pts who were non-Shanghai residents were less complete therefore excluded. Post-operative mortality, pathologic results and survival outcome for pts treated by surgical training, i.e., sub-specialized vs., non-specialized, were obtained. Survival was calculated by the Kaplan-Meier method and Log-rank test was used to determine statistical significance. To determine whether sub-specialty surgical training was an independent factor for overall survival (OS), univariate and multivariate analyses were performed using Cox proportional hazards regression. Results: Total 5,046 pts underwent R0 or R1 GC resection were identified.1594 pts had complete covariate data, survival information and were included in the study. Of them, the sub-specialized group included 217 cases treated by 3 surgeons, while the non-specialized group included 1377 cases treated by 52 surgeons. 5-year cumulative OS was higher in the sub-specialized group (62.9% vs. 54.6%, p=0.032). Multivariate analysis showed that tumor stage(p<0.001), location of tumor (p=0.003), vascular invasion (p<0.001) and surgeon (HR=1.54, p=0.001) were all associated with OS. The incidence of positive margin was higher in non-specialized group (2.0% vs. 2.7%, p<0.001) and the probability of retrieved lymph nodes less than 15 was more in non-specialized group (25.9% vs. 7.3%, p<0.001). Postoperative mortality was also higher in non-specialized group than in specialized group(1.5% vs. 0.9%, p<0.001). Conclusions: In high volume general hospital, sub-specialty training is desirable in gastric cancer surgery, the quality of gastric cancer surgery can be further improved by sub-specialty training leading to better treatment outcome.

Download Full-text

Postoperative mortality after esophageal and gastric cancer surgery: Does age still matter? Results from a nationwide study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.122 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 122-122

Author(s):

Christophe Mariette ◽

Arnaud Pasquer ◽

Florence Renaud ◽

Flora Hec ◽

Anne Gandon ◽

...

Keyword(s):

Gastric Cancer ◽

Age Groups ◽

Postoperative Mortality ◽

Linear Increase ◽

Cancer Surgery ◽

Charlson Score ◽

Cumulative Impact ◽

Study Objective ◽

Gastric Cancer Surgery ◽

The Impact

122 Background: More than age, patient comorbidity is increasingly considered as the prominent predictor of postoperative mortality (POM) in esophageal and gastric cancer surgery, leading a growing number of elderly to be operated on. However, the respective impact of age and comorbidity on POM remains to be elucidated. The study objective was to investigate the impact of age on POM according to patient comorbidity. Methods: All consecutive patients who underwent esophageal or gastric cancer surgery between 2010 and 2012 in France were included (n = 11,196). The 30-day POM was compared by age groups (20-39, 40-59, 60-79, ≥ 80) and stratified according to the Charlson score (0, 1-2, ≥ 3). The consistency across esophageal (n = 3286) and gastric (n = 7910) subgroups and variations between 30-day and 90-day POM were analyzed. Results: Patients ≥ 60 years represented 73.8% of cases. A linear increase in 30-day and 90-day POM was observed with increasing age, with rates of 0.9% and 2.1%, 2.4% and 5.4%, 4.8% and 8.8%, and 9.3% and 15.9% in 20-39, 40-59, 60-79, ≥ 80 years age groups, respectively ( P< 0.001). Comparing 20-39 and ≥ 80 years age groups, 30-day POM was 1.0% vs. 7.0% for Charlson 0 ( P< 0.001), 3.1% vs. 11.1% for Charlson1-2 ( P< 0.001) and 0% vs. 19.5% for Charlson ≥ 3 ( P= 0.020) patients. A similar linear increase of POM by growing age groups was observed for 90-day POM and in esophagus and stomach subgroups. By multivariable analysis age groups (OR 1.03 95%CI 1.02-1.04, p < 0.001) and Charlson score (OR 1.56 95%CI 1.43-1.70, p < 0.001) were independent predictors of POM. Conclusions: Age and patient comorbidity have a similar and cumulative impact on POM after esophageal and gastric cancer surgery.

Download Full-text