J Gastric Cancer.  2017 Sep;17(3):246-254. 10.5230/jgc.2017.17.e31.

Does Hospital Volume Really Affect the Surgical and Oncological Outcomes of Gastric Cancer in Korea?

• Kim EY
• Song KY
• Lee J

• KMID: 2389829
• DOI: http://doi.org/10.5230/jgc.2017.17.e31

Abstract

PURPOSE
The significance of hospital volume remains inconsistent and controversial. In particular, few studies have examined whether hospital volume is associated with the outcome of gastrectomy for gastric cancer in East Asia. This study examined the effect of hospital volume on the short-term surgical and long-term oncological outcomes of patients undergoing curative gastrectomy for gastric cancer.
MATERIALS AND METHODS
Between 2009 and 2011, 1,561 patients underwent curative gastrectomy for gastric cancer at Seoul St. Mary's Hospital (n=1,322) and Bucheon St. Mary's Hospital (n=239). We defined Seoul St. Mary's Hospital as a high-volume center and Bucheon St. Mary's Hospital as a low-volume center.
RESULTS
The extent of resection, rate of combined resection, tumor stage, operating time, and hospital stay did not differ significantly between the 2 hospitals. In addition, the hospital volume was not significantly associated with the 30-day morbidity and mortality. When the overall and disease-free survival rates of the patients were stratified according to stage, hospital volume was not significantly associated with prognosis at any stage.
CONCLUSIONS
Hospital volume might not be a decisive factor with respect to the surgical and oncological outcomes of patients if well-trained surgeons perform gastrectomy for gastric cancer.

Keyword

Hospital size; Prognosis; Gastrectomy; Stomach neoplasms

MeSH Terms

Disease-Free Survival
Far East
Gastrectomy
Gyeonggi-do
Health Facility Size
Humans
Korea*
Length of Stay
Mortality
Prognosis
Seoul
Stomach Neoplasms*
Surgeons

Figure

• 

  Fig. 1 OS according to tumor stage for the 2 hospital volume groups: (A) all patients (P=0.561); patients with (B) stage I (P=0.659), (C) stage II (P=0.778), and (D) stage III tumors (P=0.430). OS = overall survival.

• 

  Fig. 2 DFS analysis according to tumor stage for the 2 hospital volume groups: (A) all patients (P=0.998); patients with (B) stage I (P=0.503), (C) stage II (P=0.625), and (D) stage III tumors (P=0.756). DFS = disease-free survival.

Reference

1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015; 65:87–108.

2. Kim M, Park J, Kim SG, Choi S, Yoon S, Lee S. Feasibility of gastric cancer surgery at low volume hospitals. J Gastric Cancer. 2010; 10:234–240.

3. Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. 1979. Clin Orthop Relat Res. 2007; 3–9.

4. Institute of Medicine, National Research Council National Cancer Policy Board (US). Hewitt M, Petitti D, editors. Interpreting the Volume-Outcome Relationship in the Context of Cancer Care. Washington, D.C.: National Academy Press;2001.

5. Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002; 346:1128–1137.

6. Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011; 364:2128–2137.

7. Murata A, Muramatsu K, Ichimiya Y, Kubo T, Fujino Y, Matsuda S. Influence of hospital volume on outcomes of laparoscopic gastrectomy for gastric cancer in patients with comorbidity in Japan. Asian J Surg. 2015; 38:33–39.

8. Ichikawa D, Komatsu S, Kubota T, Okamoto K, Deguchi K, Tamai H, et al. Effect of hospital volume on long-term outcomes of laparoscopic gastrectomy for clinical stage I gastric cancer. Anticancer Res. 2013; 33:5165–5170.

9. Yun YH, Kim YA, Min YH, Park S, Won YJ, Kim DY, et al. The influence of hospital volume and surgical treatment delay on long-term survival after cancer surgery. Ann Oncol. 2012; 23:2731–2737.

10. Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Hospital volume and quality of laparoscopic gastrectomy in Japan. Dig Surg. 2009; 26:422–429.

11. Nakajima T. Gastric cancer treatment guidelines in Japan. Gastric Cancer. 2002; 5:1–5.

12. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14:113–123.

13. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250:187–196.

14. Sosa JA, Bowman HM, Gordon TA, Bass EB, Yeo CJ, Lillemoe KD, et al. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg. 1998; 228:429–438.

15. Birkmeyer JD, Warshaw AL, Finlayson SR, Grove MR, Tosteson AN. Relationship between hospital volume and late survival after pancreaticoduodenectomy. Surgery. 1999; 126:178–183.

16. Hata T, Motoi F, Ishida M, Naitoh T, Katayose Y, Egawa S, et al. Effect of hospital volume on surgical outcomes after pancreaticoduodenectomy: a systematic review and meta-analysis. Ann Surg. 2016; 263:664–672.

17. Yao SL, Lu-Yao G. Population-based study of relationships between hospital volume of prostatectomies, patient outcomes, and length of hospital stay. J Natl Cancer Inst. 1999; 91:1950–1956.

18. Ellison LM, Heaney JA, Birkmeyer JD. The effect of hospital volume on mortality and resource use after radical prostatectomy. J Urol. 2000; 163:867–869.

19. Wilt TJ, Shamliyan TA, Taylor BC, MacDonald R, Kane RL. Association between hospital and surgeon radical prostatectomy volume and patient outcomes: a systematic review. J Urol. 2008; 180:820–828.

20. Anderson O, Ni Z, Møller H, Coupland VH, Davies EA, Allum WH, et al. Hospital volume and survival in oesophagectomy and gastrectomy for cancer. Eur J Cancer. 2011; 47:2408–2414.

21. Coupland VH, Lagergren J, Lüchtenborg M, Jack RH, Allum W, Holmberg L, et al. Hospital volume, proportion resected and mortality from oesophageal and gastric cancer: a population-based study in England, 2004–2008. Gut. 2013; 62:961–966.

22. 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.

23. 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.

24. Lundström NR, Berggren H, Björkhem G, Jögi P, Sunnegârdh J. Centralization of pediatric heart surgery in Sweden. Pediatr Cardiol. 2000; 21:353–357.

25. Ajani JA, Bentrem DJ, Besh S, D’Amico TA, Das P, Denlinger C, et al. Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines. J Natl Compr Canc Netw. 2013; 11:531–546.