Are treatment outcomes in gastric cancer associated with either hospital volume or surgeon volume?

Abstract

Surgical resection is the only curative treatment for gastric cancer. Postoperative outcomes may be affected by the average or total number of surgeries carried out at an institution (hospital volume) or by a surgeon (surgeon volume). Among seven large‐scale studies that each enrolled over 10 000 patients who underwent gastrectomy, six showed that higher hospital volume contributed to a lower mortality rate after gastrectomy. Surgeon volume was also reported by three of four studies that each included over 1000 patients to be a significant factor contributing to heterogeneity in mortality rates after gastrectomy. In contrast, most studies showed no relationship between hospital volume and postoperative morbidity. A significant long‐term relationship was demonstrated in four of nine studies that each included more than 1000 patients, but the other five studies showed negative results. A recent correlative study of randomized phase III trials for gastric cancer surgeries showed a significant relationship between hospital volume and postoperative morbidity in one trial but not in another trial. There was no correlation between overall survival and either hospital or surgeon volume. In addition, another correlative study of a phase III trial of randomized chemotherapy for unresectable or recurrent gastric cancer found that there was no correlation between hospital volume and overall survival, although there was a large degree of heterogeneity in median overall survival among participating institutions.

Postoperative Morbidity and Failure to Rescue in Surgery for Gastric Cancer: A Single Center Retrospective Cohort Study of 1107 Patients from 1972 to 2014

“…Failure to rescue rates were 28.1% in very low-volume hospitals versus 22.7% in very high-volume hospitals [8]. According to most definitions, institutions with an average of about 50 gastroesophageal resections for malignant indications per year are regarded as high-volume centers [10]. The reported mortality rates of our patients operated on between 1972 and 1992 were consistent with the findings of a recent retrospective cohort study based on American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) data: 30-day mortality was 5.2% [11].…”

D2 Lymphadenectomy for Gastric Adenocarcinoma: Long-term Results and the Impact of Surgeon Experience on the Survival Rates

“…Thus, surgeon case-load was associated with postoperative mortality after radical gastrectomies for GC in few studies, as two reviews have shown (37,38). Two systematic reviews published in 2012 and 2017 did not identify any correlation between hospital volume of gastrectomies and postoperative complications in the most substantial part of reported studies (37,38). However, a higher hospital volume was associated with lower mortality rates (37,38).…”

“…Two systematic reviews published in 2012 and 2017 did not identify any correlation between hospital volume of gastrectomies and postoperative complications in the most substantial part of reported studies (37,38). However, a higher hospital volume was associated with lower mortality rates (37,38). The assessment of the impact of hospital volume on the long-term survival of patients with radical gastrectomies for GC reached conflicting results.…”

“…The assessment of the impact of hospital volume on the long-term survival of patients with radical gastrectomies for GC reached conflicting results. Thus, few studies associated a high-volume hospital with statistically significant better long-term survivals, while others did not (37,38).…”

Update on the Treatment of Gastric Cancer

“…Therefore, different gastric cancer treatments have been developed in Japan than in Western countries. Japanese surgeons have been influential in the development of gastric cancer surgery worldwide (3) , (4) , introducing techniques such as gastrectomy with extended lymphadenectomy. In the West, major treatment strategies include more limited lymph node dissection and chemotherapy or chemoradiotherapy (5) , (6) .…”