J Gastric Cancer.  2010 Dec;10(4):234-240.

Feasibility of Gastric Cancer Surgery at Low Volume Hospitals

• Kim M
• Park J
• Kim SG
• Choi S
• Yoon S
• Lee S

Abstract

PURPOSE
Most gastric cancer patients undergo operations at large tertiary hospitals in Korea. However, some patients are treated at low volume hospitals. We investigated patient outcomes after gastric surgery at a secondary hospital and compared with outcomes of large volume centers.
MATERIALS AND METHODS
We included 184 patients who underwent gastric surgery for gastric cancer at our hospital from January 2003 to December 2008. We conducted a retrospective study and evaluated the clinicopathological characteristics, clinical outcomes and survival rate of patients.
RESULTS
Mean age was 61.7 years old. Male to female ratio was 2.2 : 1. Proportion of early gastric cancer was 38.6% and that of advanced gastric cancer was 61.4%. The 5 year overall survival rate of 184 patients was 66.3%. The overall survival rate was significantly lower for people over 62 years old. The morbidity rate and mortality at our hospital were 10.3% and 0.5%, respectively.
CONCLUSIONS
The overall survival rate, morbidity and mortality were similar to those of the previous reports from Korea. Treatment of gastric cancer at a secondary hospital is feasible and safe. Standardization of operations and management of gastric cancer patients of the Korean Gastric Cancer Association is the most important factor to achieve these outcomes.

Keyword

Stomach neoplasms; General surgery; Survival; Low volume center; Reference standards

MeSH Terms

Female
Hospitals, Low-Volume
Humans
Korea
Male
Retrospective Studies
Stomach Neoplasms
Survival Rate
Tertiary Care Centers

Figure

• 

  Fig. 1 Kaplan-Meier survival curves according to tumor stages.

Reference

1. Smith JK, McPhee JT, Hill JS, Whalen GF, Sullivan ME, Litwin DE, et al. National outcomes after gastric resection for neoplasm. Arch Surg. 2007. 142:387–393.

2. Ministry for Health, Welfare and Family Affairs. Annual report of cancer incidence (2007), cancer prevalence (2007) and survival (1993-2007) in Korea. 2009.

3. Kim KY, Yoo MW, Han HS, Yun IJ, Lee KY. The results of gastric cancer surgery during the early stage of a training hospital. J Korean Gastric Cancer Assoc. 2008. 8:244–249.

4. Song KY, Kim SN, Park CH. Critical pathway for operable gastric cancer. J Korean Gastric Cancer Assoc. 2005. 5:95–100.

5. Finlayson EV, Goodney PP, Birkmeyer JD. Hospital volume and operative mortality in cancer surgery: a national study. Arch Surg. 2003. 138:721–725.

6. Hansson LE, Sparén P, Nyrén O. Survival in stomach cancer is improving: results of a nationwide population-based Swedish study. Ann Surg. 1999. 230:162–169.

7. Damhuis RA, Meurs CJ, Dijkhuis CM, Stassen LP, Wiggers T. Hospital volume and post-operative mortality after resection for gastric cancer. Eur J Surg Oncol. 2002. 28:401–405.

8. Reavis KM, Hinojosa MW, Smith BR, Wooldridge JB, Krishnan S, Nguyen NT. Hospital volume is not a predictor of outcomes after gastrectomy for neoplasm. Am Surg. 2009. 75:932–936.

9. Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ. Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg. 2005. 92:1099–1102.

10. Cho SH, Kim BS, Kim YH, Lee CH, Yook JH, Oh ST, et al. Clinical analysis of post-operative complications in gastric tumors. J Korean Surg Soc. 2001. 61:498–503.

11. Lee HJ, Yang HK. Quality assurance of gastric cancer surgery. J Korean Gastric Cancer Assoc. 2005. 5:79–88.

12. Nomura E, Tsukuma H, Ajiki W, Oshima A. Population-based study of relationship between hospital surgical volume and 5-year survival of stomach cancer patients in Osaka, Japan. Cancer Sci. 2003. 94:998–1002.

13. Enzinger PC, Benedetti JK, Meyerhardt JA, McCoy S, Hundahl SA, Macdonald JS, et al. Impact of hospital volume on recurrence and survival after surgery for gastric cancer. Ann Surg. 2007. 245:426–434.

14. Seo WH, Seo BJ, Yu HJ, Lee WY, Lee HK. Analysis of prognostic factors in 1,435 surgically treated patients with gastric cancer. J Korean Gastric Cancer Assoc. 2009. 9:143–151.

15. Noh SH, Yoo CH, Kim YI, Kim CB, Min JS, Lee KS. Results after a gastrectomy of 2,603 patients with gastric cancer: analysis of survival rate and prognostic factor. J Korean Surg Soc. 1998. 55:206–213.

16. Park JI, Jin SH, Bang HY, Paik NS, Moon NM, Lee JI. Survival rates after operation for gastric cancer: fifteen-year experience at a Korea cancer center hospital. J Korean Gastric Cancer Assoc. 2008. 8:9–19.

17. The Information Committee of the Korean Gastric Cancer Association. 2004 nationwide gastric cancer report in Korea. J Korean Gastric Cancer Assoc. 2007. 7:47–54.

18. Korean Gastric Cancer Association. Korean classification of gastric cancer. J Korean Gastric Cancer Assoc. 2002. 2:33–42.