Abstract：
BACKGROUND: The relationship between hospital volume and surgical mortality is well documented. However, complete centralization of surgical care is not always feasible. The present study investigates how overall volume of upper gastrointestinal surgery at hospitals influences patient outcomes following resection for gastric adenocarcinoma.
METHODS: National Cancer Database (2010-2019) patients with pathologic stage 1-3 gastric adenocarcinoma who underwent gastrectomy were identified. Three cohorts were created: low-volume hospitals (LVH) for both gastrectomy and overall upper gastrointestinal operations, mixed-volume hospital (MVH) for low-volume gastrectomy but high-volume overall upper gastrointestinal operations, and high-volume gastrectomy hospitals (HVH). Chi-squared tests were used to analyze sociodemographic factors and surgical outcomes and Kaplan-Meier method for survival analysis.
RESULTS: In total, 26,398 patients were identified (LVH: 20,099; MVH: 539; HVH: 5,760). The 5-year survival was equivalent between MVH and HVH for all stages of disease (MVH: 56.0%, HVH 55.6%; p = 0.9866) and when stratified into early (MVH: 69.9%, HVH: 65.4%; p = 0.1998) and late stages (MVH: 24.7%, HVH: 32.0%; p = 0.1480), while LVH had worse survival. After matching patients, postoperative outcomes were worse for LVH, but there was no difference between MVH and HVH in terms of adequate lymphadenectomy, margin status, readmission rates, and 90-day mortality rates.
CONCLUSIONS: Despite lower gastrectomy volume for cancer, postoperative gastrectomy outcomes at centers that perform a high number of upper gastrointestinal cancer surgeries were similar to hospitals with high gastrectomy volume. These hospitals offer a blueprint for providing equivalent outcomes to high volume centers while enhancing availability of quality cancer care.
METHODS: National Cancer Database (2010-2019) patients with pathologic stage 1-3 gastric adenocarcinoma who underwent gastrectomy were identified. Three cohorts were created: low-volume hospitals (LVH) for both gastrectomy and overall upper gastrointestinal operations, mixed-volume hospital (MVH) for low-volume gastrectomy but high-volume overall upper gastrointestinal operations, and high-volume gastrectomy hospitals (HVH). Chi-squared tests were used to analyze sociodemographic factors and surgical outcomes and Kaplan-Meier method for survival analysis.
RESULTS: In total, 26,398 patients were identified (LVH: 20,099; MVH: 539; HVH: 5,760). The 5-year survival was equivalent between MVH and HVH for all stages of disease (MVH: 56.0%, HVH 55.6%; p = 0.9866) and when stratified into early (MVH: 69.9%, HVH: 65.4%; p = 0.1998) and late stages (MVH: 24.7%, HVH: 32.0%; p = 0.1480), while LVH had worse survival. After matching patients, postoperative outcomes were worse for LVH, but there was no difference between MVH and HVH in terms of adequate lymphadenectomy, margin status, readmission rates, and 90-day mortality rates.
CONCLUSIONS: Despite lower gastrectomy volume for cancer, postoperative gastrectomy outcomes at centers that perform a high number of upper gastrointestinal cancer surgeries were similar to hospitals with high gastrectomy volume. These hospitals offer a blueprint for providing equivalent outcomes to high volume centers while enhancing availability of quality cancer care.
摘要：
背景：医院容量与手术死亡率之间的关系已有充分的文献记载。然而,外科护理的完全集中并不总是可行的。本研究调查了医院上消化道手术的总体积如何影响胃腺癌切除术后患者的预后。
方法：国家癌症数据库（2010-2019年）的病理1-3期胃腺癌患者接受胃切除术。创建了三个队列：用于胃切除术和整体上消化道手术的低容量医院（LVH）。混合容量医院（MVH）用于低容量胃切除术，但高容量的整体上消化道手术，和高容量胃切除术医院（HVH）。使用卡方检验分析社会人口统计学因素和手术结果，并使用Kaplan-Meier方法进行生存分析。
结果：总计，确定了26,398名患者(LVH:20,099;MVH:539;HVH:5,760)。对于所有疾病阶段，MVH和HVH之间的5年生存率相等（MVH：56.0％，HVH55.6%；p=0.9866)，当分层为早期时(MVH：69.9%，HVH：65.4％；p=0.1998）和晚期（MVH：24.7％，HVH：32.0%；p=0.1480），而LVH的生存率较差。匹配患者后，LVH的术后结局更差，但是MVH和HVH在适当的淋巴结清扫术方面没有差异，边距状态,再入院率，90天死亡率。
结论：尽管胃癌切除体积较小，在进行大量上消化道肿瘤手术的中心,术后胃切除术的结局与胃切除术量大的医院相似.这些医院提供了一个蓝图，为高容量中心提供同等的结果，同时提高高质量癌症护理的可用性。
方法：国家癌症数据库（2010-2019年）的病理1-3期胃腺癌患者接受胃切除术。创建了三个队列：用于胃切除术和整体上消化道手术的低容量医院（LVH）。混合容量医院（MVH）用于低容量胃切除术，但高容量的整体上消化道手术，和高容量胃切除术医院（HVH）。使用卡方检验分析社会人口统计学因素和手术结果，并使用Kaplan-Meier方法进行生存分析。
结果：总计，确定了26,398名患者(LVH:20,099;MVH:539;HVH:5,760)。对于所有疾病阶段，MVH和HVH之间的5年生存率相等（MVH：56.0％，HVH55.6%；p=0.9866)，当分层为早期时(MVH：69.9%，HVH：65.4％；p=0.1998）和晚期（MVH：24.7％，HVH：32.0%；p=0.1480），而LVH的生存率较差。匹配患者后，LVH的术后结局更差，但是MVH和HVH在适当的淋巴结清扫术方面没有差异，边距状态,再入院率，90天死亡率。
结论：尽管胃癌切除体积较小，在进行大量上消化道肿瘤手术的中心,术后胃切除术的结局与胃切除术量大的医院相似.这些医院提供了一个蓝图，为高容量中心提供同等的结果，同时提高高质量癌症护理的可用性。
