内镜黏膜下剥离术治疗胃癌：医院容量对并发症和住院时间的影响。
Endoscopic submucosal dissection for gastric cancer: the influence of hospital volume on complications and length of stay.
机构信息
Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan,
出版信息
Surg Endosc. 2014 Apr;28(4):1298-306. doi: 10.1007/s00464-013-3326-4. Epub 2013 Dec 13.
BACKGROUND
Little information is available about the relationship between hospital volume and the clinical outcome of endoscopic submucosal dissection (ESD) for gastric cancer. The purpose of this study was to investigate the influence of hospital volume on clinical outcomes of ESD using a national administrative database.
METHODS
A total of 27,385 patients treated with ESD for gastric cancer were referred to 867 hospitals between 2009 and 2011 in Japan. We collected patients' data from the administrative database to compare ESD-related complications and length of stay (LOS) in relation to hospital volume. Hospital volume was categorized into three groups based on the number of cases treated over the study period: low-volume hospitals (LVHs, <50 cases), medium-volume hospitals (MVHs, 50-100 cases), and high-volume hospitals (HVHs, >100 cases). These analyses were performed for each location of gastric cancer [upper (cardia and fundus), middle (body), and lower third (antrum and pylorus)].
RESULTS
Significant differences in ESD-related complications among the three hospital volume categories were observed for upper gastric cancer (6.5 % in LVHs vs. 5.2 % in MVHs vs. 3.4 % in HVHs; p = 0.017). Multiple logistic regression revealed that HVHs were significantly associated with decreased relative risk of ESD-related complications in upper gastric cancer (odds ratio for HVHs 0.51; 95 % confidence interval, 0.31-0.83, p = 0.007). However, no significant differences for ESD-related complications were seen for middle and lower gastric cancers among the different hospital volume categories (p > 0.05). Additionally, hospital volume was significantly associated with a decreasing LOS for all locations of gastric cancers (p < 0.001).
CONCLUSIONS
The present study has demonstrated that hospital volume was mainly associated with clinical outcome in patients with ESD for upper gastric cancer. Further studies for successive monitoring of outcomes of ESD should be conducted in the near future.
背景
关于医院容量与内镜黏膜下剥离术（ESD）治疗胃癌的临床结果之间的关系，信息有限。本研究旨在利用国家行政数据库研究医院容量对 ESD 临床结果的影响。
方法
2009 年至 2011 年间，日本 867 家医院共收治 27385 例接受 ESD 治疗的胃癌患者。我们从行政数据库中收集患者数据，比较与医院容量相关的 ESD 相关并发症和住院时间（LOS）。根据研究期间治疗的病例数，将医院容量分为三组：低容量医院（LVH，<50 例）、中容量医院（MVH，50-100 例）和高容量医院（HVH，>100 例）。对胃癌的三个部位[上（贲门和胃底）、中（体）和下三分之一（胃窦和幽门）]进行了这些分析。
结果
上消化道癌三组医院容量间 ESD 相关并发症差异有统计学意义（LVH 为 6.5%，MVH 为 5.2%，HVH 为 3.4%；p=0.017）。多因素 logistic 回归显示，HVH 与上消化道癌 ESD 相关并发症的相对风险降低显著相关（HVH 的比值比为 0.51；95%置信区间，0.31-0.83，p=0.007）。然而，不同医院容量组间中下部胃癌的 ESD 相关并发症差异无统计学意义（p>0.05）。此外，医院容量与所有部位胃癌的 LOS 呈显著负相关（p<0.001）。
结论
本研究表明，医院容量主要与接受 ESD 治疗的上消化道癌患者的临床结果相关。在不久的将来，应进行进一步的研究，以连续监测 ESD 的治疗结果。
Zotero 插件