Elsevier

European Journal of Cancer

Volume 47, Issue 16, November 2011, Pages 2408-2414
European Journal of Cancer

Hospital volume and survival in oesophagectomy and gastrectomy for cancer

https://doi.org/10.1016/j.ejca.2011.07.001Get rights and content

Abstract

Background

High volume upper gastrointestinal cancer hospitals demonstrate improved postoperative mortality rates, but the impact on survival is unclear. This population-based cohort study explores the effect of hospital volume on survival following upper gastrointestinal cancer surgery.

Patients and methods

This study used a population-based cohort of 3866 patients who underwent surgery for oesophageal or gastric cancer between 1998 and 2008 with follow-up until December 2008.

Results

Hospital volume ranged from 1 to 68 cases/year. Overall, 5-year survival was 27%. Increasing age and advanced stage of disease were independently correlated with shorter survival. High hospital volume was significantly and independently correlated with improved 30-day mortality postoperatively (P < 0.001), but not with survival beyond 30 days.

Conclusion

The correlation between hospital volume and improved 30-day mortality following oesophageal and gastric cancer surgery supports the centralisation of upper gastrointestinal cancer surgery services. The low survival in both high and low volume hospitals beyond 30 days highlights the need for increasing earlier diagnosis and optimising approaches to radical treatment.

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.

References (29)

  • A. Ioka et al.

    Hospital procedure volume and survival of cancer patients in Osaka, Japan: a population-based study with latest cases

    Jpn J Clin Oncol

    (2007)
  • C. Verhoef et al.

    Better survival in patients with esophageal cancer after surgical treatment in university hospitals: a plea for performance by surgical oncologists

    Ann Surg Oncol

    (2007)
  • M.W. Wouters et al.

    High-volume versus low-volume for esophageal resections for cancer: The essential role of case-mix adjustments based on clinical data

    Ann Surg Oncol

    (2008)
  • J. Wenner et al.

    The influence of surgical volume on hospital mortality and 5-year survival for carcinoma of the oesophagus and gastric cardia

    Anticancer Res

    (2005)
  • Cited by (0)

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