Annual hospital volume of surgery for gastrointestinal cancer in relation to prognosis

Gottlieb‐Vedi, Eivind; Mattsson, Fredrik; Lagergren, Pernilla; Lagergren, Jesper

doi:10.1016/j.ejso.2019.03.016

Cited by 18 publications

(9 citation statements)

References 34 publications

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“…Finally, our study demonstrates an association between CRM involvement after colon cancer surgery and low facility volume. While this has never been definitely established for colon cancer, there is a strong correlation between facility volume and patient outcomes for other organs, including pancreas, thyroid, rectum, and esophagus …”

Section: Discussionmentioning

confidence: 99%

Positive circumferential resection margins following locally advanced colon cancer surgery: Risk factors and survival impact

Goffredo

Zhou

Ginader

et al. 2019

Journal of Surgical Oncology

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Background: While the prognostic implications of positive circumferential resection margins (CRM) have been established for rectal cancer, its significance in colon cancer has not been well defined. The aim of the current study was to determine national rates for positive CRM in locally advanced colon cancer, associated factors, and survival impact.Methods: The National Cancer Database was queried to identify patients with stage II-III adenocarcinoma of the colon (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015).Results: Positive CRM was identified in 9% of stage II and 12% of stage III patients.Factors associated with negative CRM included surgery in a high-volume facility, adequate lymph-node harvest, and negative distal/proximal margins. No difference in CRM rates was observed between surgical approaches, although having a positive CRM was significantly associated with higher conversion rates. Positive CRM was associated with significantly lower overall survival on both univariate and multivariable analysis.Conclusions: Positive CRM rates exceeded 10% nationally and have an adverse impact on survival. While several tumor characteristics were identified as independent risk factors, oncologic resections and surgery at high-volume centers were associated with lower rates of positive CRM. These findings emphasize the need for process improvement initiatives targeting modifiable factors, including adoption of appropriate oncologic techniques, standardized pathology reporting, and potential neoadjuvant strategies. K E Y W O R D Scircumferential resection margin, colon cancer, risk factors, survival

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Section: Discussionmentioning

confidence: 99%

Positive circumferential resection margins following locally advanced colon cancer surgery: Risk factors and survival impact

Goffredo

Zhou

Ginader

et al. 2019

Journal of Surgical Oncology

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“…For each hospital and year, the annual hospital volume was calculated as the mean of any bariatric surgery procedures during the index year and previous 3 years in one specific hospital. This strategy was chosen to reduce random variations in the annual hospital volume variable 29 . If data for fewer than 3 previous years were available, calculation of the average was based on all available years.…”

Section: Potential Risk Factorsmentioning

confidence: 99%

Reintervention or mortality within 90 days of bariatric surgery: population-based cohort study

Kauppila

Santoni

Tao

et al. 2020

British Journal of Surgery

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Background Bariatric surgery carries a risk of severe postoperative complications, sometimes leading to reinterventions or even death. The incidence and risk factors for reintervention and death within 90 days after bariatric surgery are unclear, and were examined in this study. Methods This population-based cohort study included all patients who underwent bariatric surgery in one of the five Nordic countries between 1980 and 2012. Data on surgical and endoscopic procedures, diagnoses and mortality were retrieved from national high-quality and complete registries. Multivariable Cox regression analysis was used to calculate hazard ratios (HRs), adjusted for country, age, sex, co-morbidity, type of surgery and approach, year and hospital volume of bariatric surgery. Results Of 49 977 patients, 1111 (2·2 per cent) had a reintervention and 95 (0·2 per cent) died within 90 days of bariatric surgery. Risk factors for the composite outcome reintervention/mortality were older age (HR 1·65, 95 per cent c.i. 1·36 to 2·01, for age at least 50 years versus less than 30 years) and co-morbidity (HR 2·66, 1·53 to 4·62, for Charlson co-morbidity index score 2 or more versus 0). The risk of reintervention/mortality was decreased for vertical banded gastroplasty compared with gastric bypass (HR 0·37, 0·28 to 0·48) and more recent surgery (HR 0·51, 0·39 to 0·67, for procedures undertaken in 2010 or later versus before 2000). Sex, surgical approach (laparoscopic versus open) and hospital volume did not influence risk of reintervention/mortality, but laparoscopic surgery was associated with a lower risk of 90-day mortality (HR 0·29, 0·16 to 0·53). Conclusion Reintervention and death were uncommon events within 90 days of bariatric surgery even in this unselected nationwide cohort from five countries. Older patients with co-morbidities have an increased relative risk of these outcomes.

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“…A meta-analysis suggested better long-term survival after colon and rectal cancer surgery in higher-volume hospitals, but this effect was attenuated after case-mix adjustment in colon cancer [9]. A Swedish nationwide cohort study showed that high hospital volume is associated to slightly better 5year mortality in colon cancer and better 5-year all-cause mortality for some subgroups of rectal cancer patients [10]. Taken together, it is not completely clear whether hospital volume of colorectal cancer surgery is associated with long-term mortality.…”

Section: Introductionmentioning

confidence: 99%

Annual hospital volume and colorectal cancer survival in a population-based nationwide cohort study in Finland

Sarjanoja

Klintrup

Ohtonen

et al. 2022

European Journal of Surgical Oncology

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Annual hospital volume of surgery for gastrointestinal cancer in relation to prognosis

Cited by 18 publications

References 34 publications

Positive circumferential resection margins following locally advanced colon cancer surgery: Risk factors and survival impact

Positive circumferential resection margins following locally advanced colon cancer surgery: Risk factors and survival impact

Reintervention or mortality within 90 days of bariatric surgery: population-based cohort study

Annual hospital volume and colorectal cancer survival in a population-based nationwide cohort study in Finland

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