Han Hong Lee1, Sang-Yong Son2, Ju Hee Lee3, Min Gyu Kim4, Hoon Hur2, Do Joong Park5. 1. Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. 2. Department of Surgery, Ajou University School of Medicine, Suwon, Korea. 3. Department of Surgery, Hanyang University Hospital, Hanyang University School of Medicine, Seoul, Korea. 4. Department of Surgery, Hanyang University Guri Hospital, Hanyang University School of Medicine, Seoul, Korea. 5. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea. djpark@snubh.org.
Abstract
BACKGROUND: Hospital volume is known to be a crucial factor in reducing postoperative morbidity and mortality in laparoscopic gastrectomy for gastric cancer. However, it is unclear whether surgeon's individual experience can overcome the effect of hospital volume. METHODS: Clinicopathologic data of initial 50 laparoscopic gastrectomy cases were collected from six gastric cancer surgeons. Half of the six surgeons worked in high-volume centers, and the other half worked in low-volume hospitals. Perioperative outcomes were compared between the high-volume centers and the low-volume hospitals. RESULTS: Three low-volume hospitals in this study contained significantly more male and older patients with a higher American Society of Anesthesiologists score than high-volume centers. Although high- and low-volume hospitals mainly used laparoscopy-assisted and totally laparoscopic approach, respectively, there were no differences between the two groups in the extent of resection, operating time, estimated blood loss, and number of collected lymph nodes. Postoperative recovery such as duration to soft diet and hospital stay did not differ between the high- and the low-volume hospitals. No significant difference was found in postoperative morbidities by Clavien-Dindo classification. There was no mortality reported in both groups of the enrolled hospitals. CONCLUSIONS: Hospital volume is not a decisive factor in affecting postoperative morbidity and mortality for well-trained beginners in laparoscopic surgery for gastric cancer.
BACKGROUND: Hospital volume is known to be a crucial factor in reducing postoperative morbidity and mortality in laparoscopic gastrectomy for gastric cancer. However, it is unclear whether surgeon's individual experience can overcome the effect of hospital volume. METHODS: Clinicopathologic data of initial 50 laparoscopic gastrectomy cases were collected from six gastric cancer surgeons. Half of the six surgeons worked in high-volume centers, and the other half worked in low-volume hospitals. Perioperative outcomes were compared between the high-volume centers and the low-volume hospitals. RESULTS: Three low-volume hospitals in this study contained significantly more male and older patients with a higher American Society of Anesthesiologists score than high-volume centers. Although high- and low-volume hospitals mainly used laparoscopy-assisted and totally laparoscopic approach, respectively, there were no differences between the two groups in the extent of resection, operating time, estimated blood loss, and number of collected lymph nodes. Postoperative recovery such as duration to soft diet and hospital stay did not differ between the high- and the low-volume hospitals. No significant difference was found in postoperative morbidities by Clavien-Dindo classification. There was no mortality reported in both groups of the enrolled hospitals. CONCLUSIONS: Hospital volume is not a decisive factor in affecting postoperative morbidity and mortality for well-trained beginners in laparoscopic surgery for gastric cancer.
Authors: Ivy N Haskins; Matthew D Kroh; Richard L Amdur; Jeffrey L Ponksy; John H Rodriguez; Khashayar Vaziri Journal: J Gastrointest Surg Date: 2017-07-25 Impact factor: 3.452