Abstract：
New Zealand has a population of only 5.5 million meaning that for many surgical procedures the country qualifies as a \"low-volume center.\" However, the health system is well developed and required to provide complex surgical procedures that benchmark internationally against comparable countries. This investigation was undertaken to review regional variation and volumes of complex resection and palliative upper gastrointestinal (UGI) surgical procedures within New Zealand.
Data pertaining to patients undergoing complex resectional UGI procedures (esophagectomy, gastrectomy, pancreatectomy, and hepatectomies) and palliative UGI procedures (esophageal stenting, enteroenterostomy, biliary enteric anastomosis, and liver ablation) in a New Zealand hospital between January 1, 2000 and December 31, 2019 were obtained from the National Minimum Dataset.
New Zealand is a low-volume center for UGI surgery (229 hepatectomies, 250 gastrectomies, 126 pancreatectomies, and 74 esophagectomies annually). Over 80% of patients undergoing hepatic resection/ablation, gastrectomy, esophagectomy, and pancreatectomy are treated in one of the six national cancer centers (Auckland, Waikato, Mid-Central, Capital Coast, Canterbury, or Southern). There is evidence of the decreasing frequency of these procedures in small centers with increasing frequency in large centers suggesting that some regionalization is occurring. Palliative procedures were more widely performed. Indigenous Māori were less likely to be treated in a nationally designated cancer center than non-Māori.
The challenge for New Zealand and similarly sized countries is to develop and implement a system that optimizes the skills and pathways that come from a frequent performance of complex surgery while maintaining system resilience and ensuring equitable access for all patients.
Data pertaining to patients undergoing complex resectional UGI procedures (esophagectomy, gastrectomy, pancreatectomy, and hepatectomies) and palliative UGI procedures (esophageal stenting, enteroenterostomy, biliary enteric anastomosis, and liver ablation) in a New Zealand hospital between January 1, 2000 and December 31, 2019 were obtained from the National Minimum Dataset.
New Zealand is a low-volume center for UGI surgery (229 hepatectomies, 250 gastrectomies, 126 pancreatectomies, and 74 esophagectomies annually). Over 80% of patients undergoing hepatic resection/ablation, gastrectomy, esophagectomy, and pancreatectomy are treated in one of the six national cancer centers (Auckland, Waikato, Mid-Central, Capital Coast, Canterbury, or Southern). There is evidence of the decreasing frequency of these procedures in small centers with increasing frequency in large centers suggesting that some regionalization is occurring. Palliative procedures were more widely performed. Indigenous Māori were less likely to be treated in a nationally designated cancer center than non-Māori.
The challenge for New Zealand and similarly sized countries is to develop and implement a system that optimizes the skills and pathways that come from a frequent performance of complex surgery while maintaining system resilience and ensuring equitable access for all patients.
摘要：
背景：新西兰只有550万人口，这意味着对于许多外科手术，该国有资格成为“低容量中心”。\"然而,卫生系统非常发达，需要提供复杂的外科手术，这些外科手术在国际上可以与可比国家进行比较。进行这项调查是为了审查新西兰境内复杂切除和姑息性上消化道（UGI）外科手术的区域变化和体积。
方法：有关接受复杂切除UGI手术的患者的数据（食管切除术，胃切除术,胰腺切除术,和肝切除术)和姑息性UGI手术(食管支架置入术，肠肠造口术,胆肠吻合术,和肝消融）在2000年1月1日至2019年12月31日之间在新西兰一家医院中从国家最低数据集获得。
结果：新西兰是UGI手术的低容量中心（229例肝切除术，250例胃切除术,126例胰腺切除术,每年74例食管切除术）。超过80%的患者接受肝切除/消融，胃切除术,食管切除术,胰腺切除术在六个国家癌症中心之一进行治疗(奥克兰，怀卡托,中环,首都海岸,坎特伯雷,或南方）。有证据表明，这些程序在小中心的频率降低，而在大中心的频率增加，表明正在发生一些区域化。姑息性手术更广泛地进行。与非毛利人相比，土著毛利人在国家指定的癌症中心接受治疗的可能性较小。
结论：新西兰和类似规模的国家面临的挑战是开发和实施一个系统，该系统可以优化复杂手术的频繁表现所带来的技能和途径，同时保持系统的弹性并确保所有患者的公平获得。
方法：有关接受复杂切除UGI手术的患者的数据（食管切除术，胃切除术,胰腺切除术,和肝切除术)和姑息性UGI手术(食管支架置入术，肠肠造口术,胆肠吻合术,和肝消融）在2000年1月1日至2019年12月31日之间在新西兰一家医院中从国家最低数据集获得。
结果：新西兰是UGI手术的低容量中心（229例肝切除术，250例胃切除术,126例胰腺切除术,每年74例食管切除术）。超过80%的患者接受肝切除/消融，胃切除术,食管切除术,胰腺切除术在六个国家癌症中心之一进行治疗(奥克兰，怀卡托,中环,首都海岸,坎特伯雷,或南方）。有证据表明，这些程序在小中心的频率降低，而在大中心的频率增加，表明正在发生一些区域化。姑息性手术更广泛地进行。与非毛利人相比，土著毛利人在国家指定的癌症中心接受治疗的可能性较小。
结论：新西兰和类似规模的国家面临的挑战是开发和实施一个系统，该系统可以优化复杂手术的频繁表现所带来的技能和途径，同时保持系统的弹性并确保所有患者的公平获得。
