Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden; Cancer and Translational Medicine Research Unit, Medical Research Center, University of Oulu and Oulu University Hospital, 90014, Oulu, Finland.
Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden.
Eur J Surg Oncol. 2018 May;44(5):632-637. doi: 10.1016/j.ejso.2018.02.212. Epub 2018 Mar 2.
Centralization of surgery improves the survival following esophagectomy for cancer, but whether university hospital setting or surgeon volume influences the reoperation rates is unknown. We aimed to clarify whether hospital status or surgeon volume are associated with a risk of reoperation after esophagectomy.
Patients who underwent esophagectomy for esophageal cancer in 1987-2010 were identified from a population-based, nationwide Swedish cohort study. University hospital status and cumulative surgeon volume were analyzed in relation to risk of reoperation or death (the latter included to avoid competing risk errors) within 30 days of surgery. Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CI), adjusted for calendar period, age, sex, comorbidity, tumor histology, stage, neoadjuvant therapy, resection margin, surgeon volume, and hospital status.
Among 1820 participants, 989 (54%) underwent esophagectomy in university hospitals and 271 (15%) died or were reoperated within 30 days of surgery. Non-university hospital status was associated with an increased risk of reoperation or death compared to university hospitals (adjusted OR 1.56, 95% CI 1.13-2.13). Regarding surgeon volume, the ORs were increased in the lower volume categories, but not statistically significant (OR 1.30, 95% CI 0.89-1.89 for surgeon volume <7 and OR 1.10, 95% CI 0.75-1.63 for surgeon volume 7-16, compared to surgeon volume >16).
The risk of reoperation or death within 30 days of esophagectomy seems to be lower in university hospitals even after adjustment for surgeon volume and other potential confounders. These results support centralizing esophageal cancer patients to university hospitals.
手术集中化可提高食管癌患者手术后的生存率，但大学医院的设置或外科医生的手术量是否会影响再次手术的发生率尚不清楚。本研究旨在明确医院状况或外科医生手术量与食管癌手术后再次手术的风险是否相关。
从一项基于人群的全国性瑞典队列研究中确定了 1987 年至 2010 年间接受食管癌切除术的患者。分析了大学医院状况和累积外科医生手术量与术后 30 天内再次手术或死亡的风险（后者包括以避免竞争风险错误）之间的关系。多变量逻辑回归提供了比值比（OR）及其 95%置信区间（CI），校正了手术时间、年龄、性别、合并症、肿瘤组织学、分期、新辅助治疗、切缘、外科医生手术量和医院状况。
在 1820 名参与者中，989 名（54%）在大学医院接受了食管癌切除术，271 名（15%）在手术后 30 天内死亡或再次手术。与大学医院相比，非大学医院的状况与再次手术或死亡的风险增加相关（校正 OR 1.56，95%CI 1.13-2.13）。关于外科医生手术量，较低的手术量类别中 OR 增加，但无统计学意义（外科医生手术量<7 时 OR 为 1.30，95%CI 0.89-1.89，外科医生手术量 7-16 时 OR 为 1.10，95%CI 0.75-1.63，与外科医生手术量>16 相比）。
即使在校正外科医生手术量和其他潜在混杂因素后，大学医院食管癌手术后 30 天内再次手术或死亡的风险似乎较低。这些结果支持将食管癌患者集中到大学医院。
