Association between hospital volume and quality of gastric cancer surgery in the CRITICS trial.

Autor: Claassen YHM; Department of Surgical Oncology, Leiden University Medical Centre, Leiden, The Netherlands., van Sandick JW; Department of Surgical Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Hartgrink HH; Department of Surgical Oncology, Leiden University Medical Centre, Leiden, The Netherlands., Dikken JL; Department of Surgical Oncology, Leiden University Medical Centre, Leiden, The Netherlands., De Steur WO; Department of Surgical Oncology, Leiden University Medical Centre, Leiden, The Netherlands., van Grieken NCT; Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands., Boot H; Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Cats A; Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Trip AK; Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Jansen EPM; Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., Meershoek-Klein Kranenbarg WM; Department of Surgical Oncology, Leiden University Medical Centre, Leiden, The Netherlands., Braak JPBM; Department of Surgical Oncology, Leiden University Medical Centre, Leiden, The Netherlands., Putter H; Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands., van Berge Henegouwen MI; Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands., Verheij M; Department of Radiation Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands., van de Velde CJH; Department of Surgical Oncology, Leiden University Medical Centre, Leiden, The Netherlands.
Jazyk: angličtina
Zdroj: The British journal of surgery [Br J Surg] 2018 May; Vol. 105 (6), pp. 728-735.
DOI: 10.1002/bjs.10773
Abstrakt: Background: Studies investigating the association between hospital volume and quality of gastric cancer surgery are lacking. In the present study, the effect of hospital volume on quality of gastric cancer surgery was evaluated by analysing data from the CRITICS (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach) trial.
Methods: Patients who underwent gastrectomy with curative intent in the Netherlands were selected from the CRITICS trial database. Annual hospital volume of participating centres was derived from the Netherlands Cancer Registry. Hospital volume was categorized into very low (1-10 gastrectomies per year per institution), low (11-20), medium (21-30) and high (31 or more), and linked to the CRITICS database. Quality of surgery was analysed by surgicopathological compliance (removal of at least 15 lymph nodes), surgical compliance (removal of indicated lymph node stations) and the Maruyama Index. Postoperative morbidity and mortality were also compared between hospital categories.
Results: Between 2007 and 2015, 788 patients were included in the CRITICS study, of whom 494 were analysed. Surgicopathological compliance was higher (86·7 versus 50·4 per cent; P < 0·001), surgical compliance was greater (52·9 versus 19·8 per cent; P < 0·001) and median Maruyama Index was lower (0 versus 6; P = 0·006) in high-volume hospitals compared with very low-volume hospitals. There was no statistically significant difference in postoperative complications or mortality between the hospital volume categories.
Conclusion: Surgery performed in high-volume hospitals was associated with better surgical quality than surgery carried out in lower-volume hospitals.
(© 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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