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Ann Surg. 2016 Nov;264(5):823-830.

Is Centralization Needed for Esophageal and Gastric Cancer Patients With Low Operative Risk?: A Nationwide Study.

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1
*Univ.Lille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France†Univ.Lille, UMR-S 1172 - JPARC - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille, France‡Inserm, UMR-S 1172, F-59000 Lille, France§Department of Digestive and Oncological Surgery, E. Herriot University Hospital, Lyon, France¶Claude Bernard Lyon 1 University, Lyon, France||SIRIC OncoLille, France**Hox-Com Analytiques, Paris, France††UniversityLille, Department of Pathology, Centre de Biologie et de Pathologie, University Hospital, Lille, France.

Abstract

OBJECTIVE:

To investigate the impact of center volume on postoperative mortality (POM) according to patient condition.

BACKGROUND:

Centralization has been shown to improve POM in esophageal and, to a lesser extent, gastric cancer surgery; however, the benefit of centralization for patients with low operative risk is questionable.

METHODS:

All consecutive patients who underwent esophageal or gastric cancer surgery between 2010 and 2012 in France were included (N = 11,196). The 30-day POM was compared in terms of the center volume (low: <20 cases per year, intermediate: 20-39, high: 40-59, and very high: ≥60) and stratified according to the Charlson score (0, 1-2, ≥3). The consistency across the esophageal (n = 3286) and gastric (n = 7910) subgroups, and variations between 30-day and 90-day POM were analyzed.

RESULTS:

Low-volume centers treated 64.2% of patients. A linear decrease in 30-day and 90-day POM was observed with increasing center volume, with rates of 5.7% and 10.2%, 4.3% and 7.9%, 3.3% and 6.7%, and 1.7% and 3.6% in low, intermediate, high, and very high-volume centers, respectively (P < 0.001). Comparing low and very high-volume centers, 30-day POM was 4.0% versus 1.1% for Charlson 0 (P = 0.001), 7.5% versus 3.4% for Charlson 1 to 2 (P < 0.001), and 14.7% versus 3.7% for Charlson ≥3 (P = 0.003) patients. A similar linear decrease was observed in the esophageal and gastric cancer subgroups. Between the low and very high-volume centers, an almost 70% reduction in the relative risk of POM was systematically observed, independent of Charlson score or tumor location.

CONCLUSIONS:

To improve POM, esophageal and gastric cancer surgery should be centralized, irrespective of the patient's comorbidity or tumor location.

PMID:
27429033
DOI:
10.1097/SLA.0000000000001768
[Indexed for MEDLINE]

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