Department of Surgery, Section of Surgical Oncology, Boston Medical Center, Boston, MA, USA.
Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Ann Surg Oncol. 2024 Aug;31(8):5293-5303. doi: 10.1245/s10434-024-15381-y. Epub 2024 May 22.
The relationship between hospital volume and surgical mortality is well documented. However, complete centralization of surgical care is not always feasible. The present study investigates how overall volume of upper gastrointestinal surgery at hospitals influences patient outcomes following resection for gastric adenocarcinoma.
National Cancer Database (2010-2019) patients with pathologic stage 1-3 gastric adenocarcinoma who underwent gastrectomy were identified. Three cohorts were created: low-volume hospitals (LVH) for both gastrectomy and overall upper gastrointestinal operations, mixed-volume hospital (MVH) for low-volume gastrectomy but high-volume overall upper gastrointestinal operations, and high-volume gastrectomy hospitals (HVH). Chi-squared tests were used to analyze sociodemographic factors and surgical outcomes and Kaplan-Meier method for survival analysis.
In total, 26,398 patients were identified (LVH: 20,099; MVH: 539; HVH: 5,760). The 5-year survival was equivalent between MVH and HVH for all stages of disease (MVH: 56.0%, HVH 55.6%; p = 0.9866) and when stratified into early (MVH: 69.9%, HVH: 65.4%; p = 0.1998) and late stages (MVH: 24.7%, HVH: 32.0%; p = 0.1480), while LVH had worse survival. After matching patients, postoperative outcomes were worse for LVH, but there was no difference between MVH and HVH in terms of adequate lymphadenectomy, margin status, readmission rates, and 90-day mortality rates.
Despite lower gastrectomy volume for cancer, postoperative gastrectomy outcomes at centers that perform a high number of upper gastrointestinal cancer surgeries were similar to hospitals with high gastrectomy volume. These hospitals offer a blueprint for providing equivalent outcomes to high volume centers while enhancing availability of quality cancer care.
医院容量与手术死亡率之间的关系已有充分记录。然而，完全集中化的外科护理并非总是可行。本研究调查了医院上消化道手术的总体容量如何影响胃腺癌切除术后患者的结局。
从国家癌症数据库（2010-2019 年）中确定了接受胃切除术的病理分期 1-3 期胃腺癌患者。创建了三个队列：低容量医院（LVH），即胃切除术和上消化道手术的总容量均较低；混合容量医院（MVH），即胃切除术容量低但上消化道手术总容量高；高容量胃切除术医院（HVH）。使用卡方检验分析社会人口统计学因素和手术结果，并使用 Kaplan-Meier 法进行生存分析。
共确定了 26398 名患者（LVH：20099 名；MVH：539 名；HVH：5760 名）。MVH 和 HVH 在所有疾病分期（MVH：56.0%，HVH：55.6%；p=0.9866）和分层为早期（MVH：69.9%，HVH：65.4%；p=0.1998）和晚期（MVH：24.7%，HVH：32.0%；p=0.1480）时的 5 年生存率相当，而 LVH 的生存率较差。在匹配患者后，LVH 的术后结果较差，但 MVH 和 HVH 在充分淋巴结清扫、切缘状态、再入院率和 90 天死亡率方面没有差异。
尽管癌症胃切除术的容量较低，但在上消化道癌症手术数量较高的中心进行胃切除术的术后结果与胃切除术容量较高的医院相似。这些医院为提供与高容量中心相当的结果，同时增强高质量癌症护理的可及性提供了蓝图。
