Eivind Gottlieb-Vedi1, Fredrik Mattsson2, Pernilla Lagergren3, Jesper Lagergren4. 1. Upper Gastrointestinal Surgery, Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm, Sweden. Electronic address: eivind.gottlieb.vedi@ki.se. 2. Upper Gastrointestinal Surgery, Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm, Sweden. 3. Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery & Cancer, Imperial College London, London, United Kingdom. 4. Upper Gastrointestinal Surgery, Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm, Sweden; School of Cancer & Pharmaceutical Sciences, King's College London, London, England, United Kingdom.
Abstract
BACKGROUND: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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).
BACKGROUND: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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).
Authors: Ali Belkouz; Stijn Van Roessel; Marin Strijker; Jacob L van Dam; Lois Daamen; Lydia G van der Geest; Alberto Balduzzi; Andrea Benedetti Cacciaguerra; Susan van Dieren; Quintus Molenaar; Bas Groot Koerkamp; Joanne Verheij; Elizabeth Van Eycken; Giuseppe Malleo; Mohammed Abu Hilal; Martijn G H van Oijen; Ivan Borbath; Chris Verslype; Cornelis J A Punt; Marc G Besselink; Heinz-Josef Klümpen Journal: Br J Cancer Date: 2022-01-17 Impact factor: 9.075
Authors: Joonas H Kauppila; Pasi Ohtonen; Tuomo Rantanen; Tuula Tyrväinen; Vesa Toikkanen; Minna Pääaho; Antti Valtola; Jari Räsänen; Raija Kallio; Eero Sihvo; Juha Saarnio; Tuomo J Karttunen; Vesa-Matti Pohjanen; Ari Ristimäki; Simo Laine; Arto Kokkola Journal: BMJ Open Date: 2020-10-16 Impact factor: 2.692