Hospital volume and survival in oesophagectomy and gastrectomy for cancer
Introduction
Centralisation of upper gastrointestinal cancer services aims to increase hospital volume and improve the outcome of oesophageal and gastric cancer surgery. In 2001, the Improving Outcomes Guidance for upper gastrointestinal cancers recommended that upper gastrointestinal cancer centres should perform at least 40 oesophagectomies and 60 gastrectomies for cancer each year.1 The process of centralising upper gastrointestinal cancer services began in 2001 and was complete in the majority of networks by 2007.2 Published reports in the United Kingdom (UK) have not shown that high hospital volume improved survival from upper gastrointestinal cancer surgery.3, 4 However, these studies used data from before 2000 and subsequent centralisation has not been assessed in relation to survival. Reports from the United States of America,5, 6 Japan,7 Netherlands8, 9 and Sweden10, 11 have shown conflicting results. The aim of this study was to examine the relationship between hospital volume and survival from upper gastrointestinal cancer surgery using recent data from a population-based cancer registration.
Section snippets
Patients and methods
A population-based cohort of 3870 patients resident in South East England (London, Kent, Surrey and Sussex Counties; population approximately 10 million in 2001),12 diagnosed with oesophageal or gastric cancer and treated operatively over an 11-year period (1998–2008) was identified by the Thames Cancer Registry using ICD-10 coded diagnoses (International Statistical Classification of Diseases and Related Health Problems 10th Revision) and OPCS-4 coded operations (Office of Population, Censuses
Results
In total, data on 3870 patients were available. Four records were excluded because of time-sequence inconsistencies. There were differences between hospital volume groups in terms of the distribution of variables; tumour topography (χ2 = 66.7, 3 d.f., P < 0.001), age (χ2 = 26.6, 6 d.f., P < 0.001), socio-economic deprivation (χ2 = 22.8, 12 d.f., P = 0.029), stage (χ2 = 31.2, 12 d.f., P = 0.002), neo-adjuvant therapy (χ2 = 195.7, 3 d.f., P < 0.001), tumour morphology (χ2 = 20.9, 9 d.f., P = 0.013) and operation (χ2 = 100.9, 3
Discussion
This population-based cohort of 3866 resected oesophageal and gastric cancer patients shows that hospital volume independently correlates with 30-day mortality postoperatively, but does not correlate with survival beyond 30 days. The 5-year survival following oesophagectomy and gastrectomy for cancer was 28% and 27%, respectively.
The influence of hospital volume on 30-day mortality was independent of the year of diagnosis, tumour characteristics (tumour stage, morphology and topography), patient
Role of the funding source
There was no funding.
Sources of support
We acknowledge the support of the Centre for Patient Safety and Service Quality at Imperial College London that is funded by the National Institute for Health Research.
Conflict of interest statement
None declared.
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