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

Liang, Yuexiang; Wu, Liangliang; Wang, Xiaona; Ding, Xiaobo; Liang, Han

doi:10.1007/s10120-014-0436-1

Cited by 19 publications

(16 citation statements)

References 21 publications

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“…Several previous studies have demonstrated an influence of surgeon volume on postoperative outcomes among patients undergoing elective and emergent surgery [13,24]. With regard to gastric cancer surgery, patients treated by high-volume and experienced surgeons have definitively better short-and long-term outcomes [25,26]. Our data shows that both hospital and surgeon volume were associated with morbidity and mortality after gastrectomy.…”

Section: Discussionsupporting

confidence: 50%

Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system

et al. 2018

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Background Despite interest in surgeon and hospital volume effects on distal gastrectomy, clinical significance has not been confirmed in a large-scale population. We studied to clarify the effects of surgeon and hospital volume on postoperative mortality after distal gastrectomy for gastric cancer among Japanese patients in a nationwide web-based data entry system. Methods We extracted data on distal gastrectomy for gastric cancer from the National Clinical Database between 2011 and 2015. The primary outcome was operative mortality. Hospital volume was divided into 3 tertiles: low (1-22 cases per year), medium (23-51) and high (52-404). Surgeon volume was divided into the 5 groups: 0-3, 4-10, 11-20, 21-50, 51 + cases per year. We calculated the 95% confidence interval (CI) for the mortality rate based on odds ratios (ORs) estimated from a hierarchical logistic regression model. Results We analyzed 145,523 patients at 2182 institutions. Operative mortality was 1.9% in low-, 1.0% in medium-and 0.5% in high-volume hospitals. The operative mortality rate decreased definitively with surgeon volume, 1.6% in the 0-3 group and 0.3% in the 51 + group. After risk adjustment for surgeon and hospital volume and patient characteristics, hospital volume was significantly associated with operative morality (medium: OR 0.64, 95% CI 0.56-0.73, P < 0.001; high: OR 0.42, 95% CI 0.35-0.51, P < 0.001). Conclusions We demonstrate that hospital volume can have a crucial impact on postoperative mortality after distal gastrectomy compared with surgeon volume in a nationwide population study. These findings suggest that centralization may improve outcomes after distal gastrectomy.

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Section: Discussionsupporting

confidence: 50%

Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system

et al. 2018

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“…Our findings differ from the study by Ramirez et al13 First, there is a growing consensus in the literature that enhanced surgical technique and rich experience can improve survival outcomes of various types of malignancies 17,18. We noticed that in the trial by Ramirez et al, the participating sites were required to submit perioperative outcomes from a minimum of any 10 minimally invasive surgery.…”

Section: Discussioncontrasting

confidence: 99%

<p>Adverse effect of laparoscopic radical hysterectomy depends on tumor size in patients with cervical cancer</p>

Hu¹,

Ming²,

Yan³

et al. 2019

CMAR

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PurposeThe study aimed to explore the survival outcomes of early-stage cervical cancer (CC) patients treated with laparoscopic/abdominal radical hysterectomy (LRH/ARH).Patients and MethodsWe performed a retrospective analysis involving women who had undergone LRH/ARH for CC in early stage during the 2013–2015 period in West China Second University Hospital. The survival outcomes and potential prognostic factors were evaluated using Kaplan–Meier method and Cox regression analysis, respectively.ResultsA total of 678 patients were included in our analysis. The overall survival (OS) and progression-free survival (PFS) between the ARH (n=423) and LRH (n=255) groups achieved no significant differences (p=0.122, 0.285, respectively). However, in patients with a tumor diameter >4 cm, the OS of the LRH group was significantly shorter than that of the ARH group (p=0.017). Conversely, in patients with a tumor diameter ≤4 cm, the LRH group had a significantly longer OS than the ARH group (p=0.013). The multivariate Cox analysis revealed that International Federation of Gynecology and Obstetrics stage, histology, parametrial invasion, and pelvic lymph node invasion were independent prognostic factors for OS and PFS, whereas surgical method was not a statistically significant predictor of OS (p=0.806) or PFS (p=0.236) in CC patients.ConclusionLRH was an alternative to ARH for surgical treatment of CC patients with a tumor diameter ≤4 cm. However, for the patients with a tumor diameter >4 cm, priority should be given to ARH.

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“…Our study confirmed that overall recurrence rate of the “D2 plus” group, especially LNs recurrence was lower than that of the D2 group. This was consistent with the results of the previous studies 3,26 . We believe that distal GC with these LNs metastasis is at local advanced stage, rather than systemic disease.…”

Section: Discussionsupporting

confidence: 94%

“D2 plus” lymphadenectomy is associated with improved survival in distal gastric cancer with clinical serosa invasion: a propensity score analysis

Liang

Cui

Cai

et al. 2019

Sci Rep

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The aim of this study was to elucidate the potential impact of “D2 plus” lymphadenectomy on the long-term survival of distal gastric cancer (GC) patients with clinical serosa invasion. A total of 394 distal GC patients with clinical serosa invasion who underwent at least standard D2 lymphadenectomy were enrolled. Patients were categorized into two groups according to the extent of lymphadenectomy: D2 group and “D2 plus” group. Propensity score matching was used to adjust for the differences in baseline characteristics. In the multivariate analysis for the whole study series, extent of lymphadenectomy was an independent prognostic factor for GC patients (P = 0.011). With the strata analysis, the significant prognostic differences between the two groups were only observed in patients at the IIIa-b or N1-3a stages. After matching, patients in “D2 plus” group still demonstrated a significantly higher 5-year overall survival rate than those in D2 group (55.3% versus 43.9%, P = 0.042). The common therapeutic value index of No. 12b, No. 12p, No. 14v and No. 13 LNs was 4.6, which was close to that of No. 5 LN station. In conclusion, “D2 plus” lymphadenectomy may be associated with improved overall survival in distal GC with clinical serosa invasion.

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

Cited by 19 publications

References 21 publications

Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system

Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system

<p>Adverse effect of laparoscopic radical hysterectomy depends on tumor size in patients with cervical cancer</p>

“D2 plus” lymphadenectomy is associated with improved survival in distal gastric cancer with clinical serosa invasion: a propensity score analysis

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