Upper Gastrointestinal Surgery, Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm, Sweden.
Upper Gastrointestinal Surgery, Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm, Sweden.
Eur J Surg Oncol. 2019 Oct;45(10):1839-1846. doi: 10.1016/j.ejso.2019.03.016. Epub 2019 Mar 15.
Studies examining hospital volume for surgery for various gastrointestinal (GI) cancer types have shown conflicting results regarding the influence on long-term prognosis. The aim of this study was to examine annual hospital volume in relation to long-term survival after elective surgery for all GI cancers (esophagus, stomach, liver, pancreas, bile ducts, small bowel, colon, and rectum).
Population-based cohort study including all 45,908 patients who underwent elective surgery for GI cancers in Sweden in 2005-2013. Follow-up was until 2016 for disease-specific 5-year mortality (main outcome) and 2018 for all-cause 5-year mortality (secondary outcome). Hospitals were divided into quartiles for each GI cancer according to a 4-year average annual volume of the year of surgery and three years earlier. Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for relevant confounders.
Higher hospital volume was associated with a survival benefit in the large group of patients (n = 26,688) who underwent colon cancer resection, with HR 0.89 (95% CI 0.84-0.96) for disease-specific 5-year mortality comparing the highest with the lowest quartile. Higher hospital volume improved 5-year mortality in sub-groups of patients who underwent surgery for cancer of the esophagus, pancreas, and rectum. No such improvements were found for cancer of the stomach, liver, bile ducts, or small bowel.
Long-term survival was improved at higher volume hospitals for some GI cancers (colon, esophagus, pancreas, rectum), but not for others (stomach, liver, bile ducts, small bowel).
研究检查了各种胃肠道（GI）癌症类型的手术医院量，结果表明其对长期预后的影响存在矛盾。本研究的目的是检查所有 GI 癌（食管，胃，肝，胰，胆管，小肠，结肠和直肠）择期手术后与长期生存相关的年度医院量。
这是一项基于人群的队列研究，包括 2005 年至 2013 年在瑞典接受 GI 癌择期手术的所有 45908 名患者。随访截止至 2016 年用于疾病特异性 5 年死亡率（主要结局）和 2018 年用于所有原因 5 年死亡率（次要结局）。根据手术年份和前三年的 4 年平均年手术量，将医院按每个 GI 癌分为四分位数。多变量 Cox 回归提供了风险比（HR）及其 95％置信区间（CI），调整了相关混杂因素。
大量患者（n=26688）行结肠癌切除术时，医院量较高与生存获益相关，疾病特异性 5 年死亡率的 HR 为 0.89（95％CI 0.84-0.96），最高四分位数与最低四分位数相比。在接受食管，胰腺和直肠癌症手术的患者亚组中，较高的医院量改善了 5 年死亡率。在胃，肝，胆管或小肠癌症患者中未发现这种改善。
对于某些 GI 癌（结肠，食管，胰腺和直肠），高容量医院的长期生存率得到了提高，但对于其他癌症（胃，肝，胆管或小肠）则不然。
