Case Volume-to-Outcome Relationship in Minimally Invasive Esophagogastrectomy

Abstract

Background:Outcomes after open esophagectomy (OE) have been shown to depend on institution case volume. We aim to determine whether a similar relationship exists for minimallyinvasive esophagogastrectomy (MIE). Methods: Patients who had OE or MIE (excluding robotic procdures) between 2010 and 2013 in the National Cancer Database were included. Outcomes included 30-and 90-day mortality, length-of-stay, hospital readmission, margin positivity, and number of lymph nodes harvested. Logistic and linear regression were used to adjust for possible confounders including age, gender, tumor size, Charlson score, induction therapy, and type of institution (academic vs. community-based). Results:We identified 2371 patients in the MIE group and 6285 patients in the OE group. In multivariate analysis, high case volume was an independent predictor for lower 30-day, 90-day mortality, shorter length-of-stay, and higher rate of negative-margin resection in OE (P<0.001) but not MIE. After quartile ranking of institutions based on volume, MIE outcomes were found to be better in institutions in the highest volume quartile compared to those in the lowest (p< 0.0001). Conclusions:In this dataset, MIE postoperative outcomes, unlike OE, did not correlate with hospital case volume. Volume-outcome relationships may be affected by surgical approach.The effect of case volume on long-term outcomes after MIE warrants further study.

Minimally Invasive Surgery and Surgical Volume-Specific Survival and Perioperative Outcome: Unmet Need for Evidence in Gynecologic Malignancy

“…A total of 3012 studies were examined, and 23 comprising 293,159 minimally invasive oncologic surgeries met the inclusion criteria and were used for the descriptive analysis [ 4 , 5 , 6 , 7 , 8 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. The study selection schema is shown in Figure 1 .…”

“…Among the 23 studies, gastrointestinal surgery was the most common surgery type (nine studies) [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], followed by genitourinary (seven studies) [ 30 , 31 , 32 , 33 , 34 , 35 , 36 ], gynecologic (four studies) [ 4 , 5 , 6 , 7 ], hepatobiliary (two studies) [ 8 , 29 ], and thoracic (one study) surgeries [ 37 ]. In the gynecologic surgery group, two studies reported the outcomes of minimally invasive hysterectomy in endometrial cancer [ 4 , 6 ].…”

“…Studies included in this review were published from 2009 to 2020. The study duration corresponding to these studies ranged from 1997 to 2015, but 22 of the 23 studies used a starting point of the 2000s [ 4 , 5 , 6 , 7 , 8 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. The majority of studies were from the United States (69.6%) [ 4 , 5 , 6 , 7 , 8 , 20 , 21 , 24 , 25 , 29 , 30 , 32 , 33 , 34 , 35 , 37 ], followed by Europe (17.4%) [ 22 , 28 , 31 , 36 ] and Japan (13.0%) [ 23 , 26 , 27 ].…”

“…The cutoff designating a high-volume center ranged from 2 to 219 surgeries a year. Three (13.0%) studies used the top decile cutoff [ 5 , 7 , 20 ], six (26.1%) used the top quartile cutoff [ 21 , 24 , 31 , 32 , 35 , 37 ], and two (8.7%) used the top third cutoff [ 4 , 33 ]. A random cutoff was used in nearly half of the studies (10; 43.5%) [ 6 , 22 , 23 , 25 , 26 , 27 , 28 , 30 , 34 , 36 ].…”

“…For example, five of the seven studies examining minimally invasive colectomy showed improved perioperative surgical morbidity at high-volume centers [ 20 , 22 , 24 , 25 , 28 ], whereas two studies showed no association [ 26 , 27 ]. Two procedures showed no association between hospital surgical volume and perioperative outcomes (minimally invasive gastrectomy and esophagectomy) [ 21 , 23 ].…”