Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven, The Netherlands.
Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
Br J Surg. 2018 Dec;105(13):1807-1815. doi: 10.1002/bjs.10931. Epub 2018 Aug 22.
Centralization of surgery has been shown to improve outcomes for oesophageal and pancreatic cancer, and has been implemented for gastric cancer since 2012 in the Netherlands. This study evaluated the impact of centralizing gastric cancer surgery on outcomes for all patients with gastric cancer.
Patients diagnosed with non-cardia gastric adenocarcinoma in the intervals 2009-2011 and 2013-2015 were selected from the Netherlands Cancer Registry. Clinicopathological data, treatment characteristics and mortality were assessed for the periods before (2009-2011) and after (2013-2015) centralization. Cox regression analyses were used to assess differences in overall survival between these intervals.
A total of 7204 patients were included. Resection rates increased slightly from 37·6 per cent before to 39·6 per cent after centralization (P = 0·023). Before centralization, 50·1 per cent of surgically treated patients underwent gastrectomy in hospitals that performed fewer than ten procedures annually, compared with 9·2 per cent after centralization. Patients who had gastrectomy in the second interval were younger and more often underwent total gastrectomy (29·3 per cent before versus 41·2 per cent after centralization). Thirty-day postoperative mortality rates dropped from 6·5 to 4·1 per cent (P = 0·004), and 90-day mortality rates decreased from 10·6 to 7·2 per cent (P = 0·002). Two-year overall survival rates increased from 55·4 to 58·5 per cent among patients who had gastrectomy (P = 0·031) and from 27·1 to 29·6 per cent for all patients (P = 0·003). Improvements remained after adjustment for case mix; however, adjustment for hospital volume attenuated this association for surgically treated patients.
Centralization of gastric cancer surgery was associated with reduced postoperative mortality and improved survival.
手术集中化已被证明可以改善食管癌和胰腺癌的治疗效果，自 2012 年以来，荷兰已经对胃癌实施了手术集中化。本研究评估了将胃癌手术集中化对所有胃癌患者的治疗效果的影响。
从荷兰癌症登记处选择了 2009-2011 年和 2013-2015 年期间被诊断为非贲门胃腺癌的患者。评估了集中化前后（2009-2011 年和 2013-2015 年）的临床病理数据、治疗特征和死亡率。使用 Cox 回归分析评估了这两个时间段之间总生存率的差异。
共纳入 7204 例患者。集中化后，切除率从 37.6%略有增加到 39.6%（P=0.023）。在集中化之前，接受手术治疗的患者中，有 50.1%在每年手术量少于 10 例的医院进行胃切除术，而集中化后这一比例为 9.2%。在第二个时间段接受胃切除术的患者年龄更小，更常接受全胃切除术（集中化前为 29.3%，集中化后为 41.2%）。术后 30 天死亡率从 6.5%降至 4.1%（P=0.004），90 天死亡率从 10.6%降至 7.2%（P=0.002）。接受胃切除术的患者的两年总生存率从 55.4%提高到 58.5%（P=0.031），所有患者的两年总生存率从 27.1%提高到 29.6%（P=0.003）。在调整病例组合后，这些改善仍然存在；然而，对医院容量的调整减弱了这种关联在接受手术治疗的患者中。
胃癌手术的集中化与术后死亡率降低和生存率提高有关。
