Odagiri Hiroyuki, Yasunaga Hideo, Matsui Hiroki, Matsui Shigeru, Fushimi Kiyohide, Kaise Mitsuru
Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
Department of Gastroenterology, Saiseikai Kawaguchi General Hospital, Saitama, Japan.
Endoscopy. 2017 Apr;49(4):321-326. doi: 10.1055/s-0042-122189. Epub 2016 Dec 14.
Esophageal endoscopic submucosal dissection (ESD) has gradually acquired popularity as a minimally invasive surgery for early cancers not only in Japan, but also in other countries. However, most reported outcomes have been based on relatively small samples of patients from specialized centers. Therefore, the association between hospital volume and the rate of adverse events following esophageal ESD has been poorly understood. Using a nationwide administrative database in Japan, we identified patients who underwent esophageal ESD between 1 July 2007 and 31 March 2013. Hospital volume was defined as the number of esophageal ESD procedures performed per year at each hospital and was categorized into quartiles. In total, 12 899 esophageal ESD procedures at 699 institutions were identified during the study period. Perforation and perforation-related disorders were observed in 422 patients (3.3 %), and one patient died after perforation. There was a significant association between a lower hospital volume and a higher proportion of adverse events following esophageal ESD. Although not statistically significant, a similar tendency was observed in the occurrence of blood transfusion within 1 week after ESD and all-cause in-hospital death. Multivariable logistic regression analysis showed that hospitals with very high case volumes were less likely to experience adverse events following esophageal ESD than hospitals with very low volumes. The proportion of perforation and perforation-related disorders following esophageal ESD was permissibly low, and there was a linear association between higher hospital volume and lower rates of adverse events following esophageal ESD.
食管内镜黏膜下剥离术（ESD）作为一种针对早期癌症的微创手术，不仅在日本，而且在其他国家也逐渐受到欢迎。然而，大多数报道的结果是基于来自专业中心的相对较少的患者样本。因此，医院手术量与食管ESD术后不良事件发生率之间的关联尚未得到充分了解。利用日本全国性的行政数据库，我们确定了2007年7月1日至2013年3月31日期间接受食管ESD的患者。医院手术量定义为每家医院每年进行的食管ESD手术数量，并分为四分位数。在研究期间，共在699家机构识别出12899例食管ESD手术。422例患者（3.3%）发生穿孔及穿孔相关疾病，1例患者穿孔后死亡。食管ESD术后医院手术量较低与不良事件比例较高之间存在显著关联。虽然ESD术后1周内输血发生率和全因院内死亡率未显示出统计学意义，但也观察到了类似趋势。多变量逻辑回归分析显示，与手术量非常低的医院相比，手术量非常高的医院食管ESD术后发生不良事件的可能性较小。食管ESD术后穿孔及穿孔相关疾病的比例较低，且医院手术量越高，食管ESD术后不良事件发生率越低，二者呈线性关联。
