Narendra Aaditya, Baade Peter D, Aitken Joanne F, Fawcett Jonathan, Leggett Brandon, Leggett Callum, Tian Kevin, Sklavos Theodore, Smithers B Mark
The University of Queensland, Princess Alexandra Hospital, Cancer Alliance Queensland, Burke Street Centre, Brisbane, Queensland, Australia.
Cancer Council Queensland, Brisbane, Queensland, Australia.
ANZ J Surg. 2021 Mar;91(3):323-328. doi: 10.1111/ans.16397. Epub 2020 Nov 5.
The impact of hospital characteristics on the quality of surgery and survival following oesophagogastric cancer surgery has not been well established in Australia. We assessed the interaction between hospital volume, service capability and surgical outcomes, with the hypothesis that both the quality of surgery and survival are better following treatment in high-volume, high service capability hospitals.
All patients undergoing oesophagectomy and gastrectomy for cancer in Queensland, between 2001 and 2015, were included. Demographic, pathology and outcome data were collected. Hospitals were categorized into high (HV) (≥5 gastrectomies; ≥6 oesophagectomies) and low volume (LV). Hospital service capability was defined as high (HS) and low (LS), and then linked to hospital volume: HVHS, LVHS and LVLS. Higher quality surgery was defined using six perioperative parameters. Univariable comparisons of quality of surgery between hospital groups used chi-squared tests. The 5-year overall survival was compared using log-rank tests and Cox proportional hazard models.
For both gastrectomy and oesophagectomy, higher quality surgery occurred more frequently in HVHS hospitals (gastrectomy: HVHS = 44.2%, LVHS = 23.1%, LVLS = 29.1% (P < 0.01); oesophagectomy: HVHS = 34.5%, LVHS = 24.4%, LVLS = 21.7% (P = 0.01)). Following oesophagectomy, the 3- and 5-year overall survival was better following treatment in HVHS (P < 0.01). There was no difference between the groups following gastrectomy.
In Queensland, the quality of surgery was higher in HVHS hospitals performing gastrectomy and oesophagectomy; however, the impact on cancer survival was only seen following oesophagectomy.
在澳大利亚，医院特征对食管癌和胃癌手术后的手术质量及生存率的影响尚未明确。我们评估了医院手术量、服务能力与手术结果之间的相互作用，假设在手术量大、服务能力强的医院接受治疗后，手术质量和生存率会更高。
纳入2001年至2015年间在昆士兰州因癌症接受食管切除术和胃切除术的所有患者。收集人口统计学、病理学和结果数据。医院被分为高手术量（HV）（≥5例胃切除术；≥6例食管切除术）和低手术量（LV）。医院服务能力被定义为高（HS）和低（LS），然后与医院手术量相关联：HVHS、LVHS和LVLS。使用六个围手术期参数来定义更高质量的手术。采用卡方检验对医院组之间的手术质量进行单变量比较。使用对数秩检验和Cox比例风险模型比较5年总生存率。
对于胃切除术和食管切除术，更高质量的手术在HVHS医院中更为频繁（胃切除术：HVHS = 44.2%，LVHS = 23.1%，LVLS = 29.1%（P < 0.01）；食管切除术：HVHS = 34.5%，LVHS = 24.4%，LVLS = 21.7%（P = 0.01））。食管切除术后，HVHS治疗后的3年和5年总生存率更好（P < 0.01）。胃切除术后各组之间没有差异。
在昆士兰州，进行胃切除术和食管切除术的HVHS医院的手术质量更高；然而，对癌症生存率的影响仅在食管切除术后可见。
