Population‐based study of relationship between hospital surgical volume and 5‐year survival of stomach cancer patients in Osaka, Japan

Nomura, Etsuko; Tsukuma, Hideaki; Ajiki, Wakiko; Oshima, Akira

doi:10.1111/j.1349-7006.2003.tb01391.x

Cited by 39 publications

(39 citation statements)

References 6 publications

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“…North American series have reported 14 or 15 gastric cancer cases per year as a marker of a high-volume gastric cancer center [27,34]. In Asia, 200 cases per year are considered a marker of a high-volume institution [37][38][39]. Gastric cancer surgery has been centralized in some countries such as the UK, Denmark, The Netherlands, Sweden, and Finland [40].…”

Section: Discussionmentioning

confidence: 99%

Treatment results of curative gastric resection from a specialist Australian unit: low volume with satisfactory outcomes

et al. 2013

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Background The incidence of gastric cancer is decreasing in Australia, yet it remains a common cause of cancerrelated mortality. Surgical resection remains the cornerstone of curative treatment. High-volume specialized units have reported superior perioperative and oncological outcomes. The role of D2 lymphadenectomy has been controversial as a result of concerns over increased morbidity. Our aim is to report the perioperative and oncological outcomes of curative gastric resection from a specialist Australian upper GI unit. Methods Data from a prospectively maintained database were reviewed for all patients undergoing curative resection for gastric adenocarcinoma from a single unit during a 12-year period. Perioperative and long-term outcomes were compiled. Results There were 255 curative gastric resections during 12 years. An R0 resection was performed in 96 % with a perioperative mortality rate of 1.6 %. A D2 dissection was performed in 85 % of cases in the past 6 years, with no increase in perioperative morbidity or mortality detected. The 5-year overall survival was 53 %. Conclusion Our results demonstrate that both short-and long-term outcomes of surgical resection in gastric cancer patients, comparable to international high-volume centers, can be achieved in an Australian upper GI unit. A D2 lymph node dissection can be performed safely without any increase in perioperative risk in a specialist unit that has the necessary training but also the perioperative support structures to manage these complex patients.

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Section: Discussionmentioning

confidence: 99%

Treatment results of curative gastric resection from a specialist Australian unit: low volume with satisfactory outcomes

et al. 2013

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“…Eligibility criteria included: (1) adenocarcinoma of the stomach, (2) patients with stage I-III disease who underwent gastrectomy with curative intent, (3) no history of gastrectomy or other malignancy and (4) no history of neoadjuvant chemotherapy. Ultimately, 976 patients were included in this study.…”

Section: Patients and Surgeonsmentioning

confidence: 99%

“…Although the prognosis of gastric cancer after surgery is mainly associated with tumor stage and other clinicopathological features, there is a growing consensus in the surgical literature that enhanced surgical technique and rich experience can improve outcomes for patients with curatively resected gastrointestinal cancer. Previous volume-outcome studies of patients with resectable gastric cancer have shown a positive association of surgical outcome with the hospital volume [1][2][3][4]. Compared with hospital volume, surgeon specialization can better predict surgical outcome in a given center.…”

Section: Introductionmentioning

confidence: 99%

The positive impact of surgeon specialization on survival for gastric cancer patients after surgery with curative intent

Liang

Wang

et al. 2014

Gastric Cancer

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Background Many studies have affirmed the survival benefit for cancer patients treated by specialized surgeons. Methods A total of 967 patients with gastric cancer (GC) who underwent gastrectomy with curative intent in our center were enrolled. Patients were categorized into two groups based on surgeon specialization: the specialized group (SG) and nonspecialized group (NSG). To overcome bias due to the different distribution of covariates for the two groups, a one-to-one match was applied using propensity score analysis. After matching, prognosis and recurrence data were analyzed. Results After one-to-one matching, 261 patients in the SG and 261 patients in the NSG had the same characteristics excluding factors associated with surgery. In multivariate analysis for the whole study series, surgeon specialization was an independent prognostic factor for GC patients after surgery. Patients in the SG demonstrated a significantly higher 5-year overall survival than those in the NSG (50.7 vs. 37.2 %, p = 0.001). With the strata analysis, significant prognostic differences between the two groups were only observed in patients at stage IIIa-b or N1-2. The proportion of locoregional recurrence was greater in the NSG than in the SG. Conclusion GC patients treated by specialized surgeons tended to have a better prognosis and lower locoregional recurrence rate. Surgeon specialization was an independent prognostic factor for GC patients after surgery. GC should be treated by specialized surgeons in large-volume centers.

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“…In contrast, a Dutch study showed that high hospital volume was associated with long‐term survival after esophagectomy, but not after gastrectomy 37. A Japanese study showed that in patients with localized or regionally metastasized gastric cancer, 5‐year survival between 1975 and 1979 was worse when resection was carried out at very low‐volume hospitals compared to high‐volume hospitals 34. This correlation, however, decreased in later time periods and disappeared in the period between 1990 and 1994, except for very low‐volume hospitals.…”

Section: Resultsmentioning

confidence: 96%

“…Since the 2000s, nine studies that each included at least 1000 patients have focused on long‐term survival after gastrectomy (Table 3), and four of these found a significant relationship between survival and hospital volume 23, 34, 35, 36. In a study from the USA showing a positive relationship between hospital volume and long‐term outcomes (HR, 0.82; 95% CI, 0.73–0.92; P <.001), differences in outcomes could not be explained by discrepancies in patient characteristics or operative mortality, suggesting that hospital volume was an independent predictor of long‐term survival after gastrectomy 35.…”

Section: Resultsmentioning

confidence: 99%

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

Mukai

Kurokawa

Takiguchi

et al. 2017

Annals of Gastroent Surgery

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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.

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Population‐based study of relationship between hospital surgical volume and 5‐year survival of stomach cancer patients in Osaka, Japan

Cited by 39 publications

References 6 publications

Treatment results of curative gastric resection from a specialist Australian unit: low volume with satisfactory outcomes

Treatment results of curative gastric resection from a specialist Australian unit: low volume with satisfactory outcomes

The positive impact of surgeon specialization on survival for gastric cancer patients after surgery with curative intent

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

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