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Hospital-Volume Effect Onto the Early Postoperative and Long-Term Oncological Outcome in the Surgical Management of Gastric Cancer
Ingo Gastinger2, Ralf Steinert3, Karsten Ridwelski4, Henry Ptok5, Marleen Ridwelski6, Meyer Frank*1, Ronny Otto6, Hans Lippert6
1Dept. of General, Abdominal & Vascular Surgery, University Hospital, Magdeburg, Germany; 2Oncosurgical practice, Cottbus, Germany; 3Dept. of General and Abdominal Surgery, St.-Josef Hospital, Salzkotten, Germany; 4Dept. of General and Abdominal Surgery, Municipal Hospital, Magdeburg, Germany; 5Dept. of Surgery, Municipal Hospital, Cottbus, Germany; 6Institute of Quality Assurance, Otto-von-Guericke University, Magdeburg, Germany
There is an assumption that the greater the number of cases is the better the outcome which might be the case for treatment of several diseases including various malignant tumor lesions. However, it has to be shown first in detail for which specific tumor lesion this is applicable.
Through the time period from 01/01/2007 to 12/31/2009, 2,879 patients with primary histologically confirmed gastric cancer were enrolled in the ongoing prospective multicenter clinical observational study (design) from 141 surgical departments of each profile of care in Germany. In 544 cases (18.8 %), tumor site was located at the esophagogastric junction (AEG 1-3). With regard to the hospital-volume effect onto the overall outcome, patients were subdivided into groups of various case numbers (< 10; < 15; < 20; > 20 cases) / year.
Interestingly, there were no significant differences in the early postoperative treatment results such as complication rates, hospital lethality) among the analyzed volume groups. In addition, the oncological long-term results were also not influenced by the case number/year. However, tumor lesions at the esophagogastric junction showed a tendency of a better long-term survival in the "high-volume" departments of surgery (in particular, in case of > 20 surgical interventions/year). In the context of i) an adequate multimodal treatment profile and ii) a required standardization of surgical technique (abdominothoracic approach, in particular, in AEG-1 and -2 tumor lesions), centralization of cases with malignant tumor lesions at the esophagogastric junction into high-volume surgical departments should be considered.
Results show that hospital-volume effect might have an impact but this has to be demonstrated first and in detail - as it could not be found in gastric cancer in a representative consecutive patient cohort as previously reported for rectal cancer.
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