Departments of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Br J Surg. 2013 Jan;100(1):83-94. doi: 10.1002/bjs.8966. Epub 2012 Nov 23.
In several European countries, centralization of oesophagogastric cancer surgery has been realized and clinical audits initiated. The present study was designed to evaluate differences in resection rates, outcomes and annual hospital volumes between these countries, and to analyse the relationship between hospital volume and outcomes.
National data were obtained from cancer registries or clinical audits in the Netherlands, Sweden, Denmark and England. Differences in outcomes were analysed between countries and between hospital volume categories, adjusting for available case-mix factors.
Between 2004 and 2009, 10 854 oesophagectomies and 9010 gastrectomies were registered. Resection rates in England were 18·2 and 21·6 per cent for oesophageal and gastric cancer respectively, compared with 28·5-29·9 and 41·4-41·9 per cent in the Netherlands and Denmark (P < 0·001). The adjusted 30-day mortality rate after oesophagectomy was lowest in Sweden (1·9 per cent). After gastrectomy, the adjusted 30-day mortality rate was significantly higher in the Netherlands (6·9 per cent) than in Sweden (3·5 per cent; P = 0·017) and Denmark (4·3 per cent; P = 0·029). Increasing hospital volume was associated with a lower 30-day mortality rate after oesophagectomy (odds ratio 0·55 (95 per cent confidence interval 0·42 to 0·72) for at least 41 versus 1-10 procedures per year) and gastrectomy (odds ratio 0·64 (0·41 to 0·99) for at least 21 versus 1-10 procedures per year).
Hospitals performing larger numbers of oesophagogastric cancer resections had a lower 30-day mortality rate. Differences in outcomes between several European countries could not be explained by differences in hospital volumes. To understand these differences in outcomes and resection rates, with reliable case-mix adjustments, a uniform European upper gastrointestinal cancer audit with recording of standardized data is warranted.
在一些欧洲国家，已经实现了食管胃交界癌手术的集中化，并启动了临床审核。本研究旨在评估这些国家之间的切除率、结果和医院年手术量的差异，并分析医院手术量与结果之间的关系。
从荷兰、瑞典、丹麦和英国的癌症登记处或临床审核中获取国家数据。分析了国家间以及医院手术量类别间的结果差异，并对可用病例组合因素进行了调整。
2004 年至 2009 年期间，登记了 10854 例食管切除术和 9010 例胃切除术。英国的食管和胃癌切除率分别为 18.2%和 21.6%，而荷兰和丹麦分别为 28.5%-29.9%和 41.4%-41.9%（P<0.001）。瑞典的食管切除术 30 天死亡率最低（1.9%）。胃切除术后，荷兰的调整后 30 天死亡率（6.9%）显著高于瑞典（3.5%；P=0.017）和丹麦（4.3%；P=0.029）。随着医院手术量的增加，食管切除术（比值比 0.55（95%置信区间 0.42 至 0.72），至少 41 例与每年 1-10 例）和胃切除术（比值比 0.64（0.41 至 0.99），至少 21 例与每年 1-10 例）的 30 天死亡率降低。
进行较多食管胃交界癌切除术的医院 30 天死亡率较低。几个欧洲国家之间的结果差异不能用医院手术量的差异来解释。为了了解这些结果和切除率的差异，需要进行具有可靠病例组合调整的统一的欧洲上消化道癌症审核，并记录标准化数据。
