Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Population and Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Ann Surg Oncol. 2021 Sep;28(9):4839-4847. doi: 10.1245/s10434-021-09655-y. Epub 2021 Feb 10.
Performance of technically complex surgery at high-volume (HV) centers is associated with improved outcomes.
The aim of this study was to assess whether hospital gastrectomy volume is associated with surgical outcomes, and what threshold of case volume meaningfully impacts surgical outcomes.
We conducted a retrospective review of adult NCDB patients with gastric adenocarcinoma undergoing gastrectomy between 2004 and 2015. A multivariable Cox proportional hazards model with restricted cubic splines was used to examine the association of annual hospital gastrectomy volume and overall survival. Bootstrap simulation was used to estimate the cut-point corresponding to maximum change in log hazard ratio. Hospitals were divided into HV (≥ 17 cases/year) and low-volume (LV; < 17 cases/year) groups. We examined the relationship between volume groups and adequate nodal examination, R0 resection, unplanned readmission, and 30- and 90-day mortality.
Our cohort consisted of 29,559 patients (7.8% treated at an HV center). Treatment at an HV center was associated with an increased likelihood of adequate nodal examination [odds ratio (OR) 2.12, 95% confidence interval (CI) 1.94-2.32] and R0 resection among patients with cardia tumors (OR 1.42, 95% CI 1.07-1.88). Patients treated at HV centers had decreased 30- and 90-day postoperative mortality, which was more pronounced in those undergoing total gastrectomy.
Treatment at an HV gastrectomy center is associated with improved surgical outcomes. Our study identified 17 cases/year as a clinically meaningful distinction between HV and LV centers. This definition of an HV center should be considered when evaluating regionalization of gastric cancer care to improve patient outcomes.
在高容量（HV）中心进行技术复杂的手术与改善结果相关。
本研究旨在评估医院胃切除术量是否与手术结果相关，以及何种病例量阈值对手术结果有意义的影响。
我们对 2004 年至 2015 年间接受胃腺癌胃切除术的 NCDB 成年患者进行了回顾性审查。使用带有限制三次样条的多变量 Cox 比例风险模型来检查年度医院胃切除术量与总生存率之间的关联。使用引导模拟来估计对应于对数风险比最大变化的切点。将医院分为高容量（≥17 例/年）和低容量（<17 例/年）组。我们检查了体积组与充分的淋巴结检查、R0 切除、非计划再入院以及 30 天和 90 天死亡率之间的关系。
我们的队列包括 29559 名患者（7.8%在 HV 中心治疗）。在接受贲门肿瘤治疗的患者中，在 HV 中心治疗与更有可能进行充分的淋巴结检查（优势比 [OR] 2.12，95%置信区间 [CI] 1.94-2.32）和 R0 切除相关。在 HV 中心接受治疗的患者术后 30 天和 90 天死亡率降低，全胃切除术患者的死亡率降低更为明显。
在 HV 胃切除术中心接受治疗与改善手术结果相关。我们的研究确定了 17 例/年作为 HV 和 LV 中心之间的临床有意义的区别。在评估胃癌治疗的区域化以改善患者预后时，应考虑将 17 例/年作为 HV 中心的定义。
