Hospital volume, proportion resected and mortality from oesophageal and gastric cancer: a population-based study in England, 2004–2008. Issue 7 (19th October 2012)

• Record Type: Journal Article
• Authors: Coupland, Victoria H; Lagergren, Jesper; Lüchtenborg, Margreet; Jack, Ruth H; Allum, William; Holmberg, Lars; Hanna, George B; Pearce, Neil; Møller, Henrik
• Is Part Of: Gut. Volume 62:Issue 7(2013)
• Page Start: 961
• Page End: 966
• Publication Date: 2012-10-19
• Subjects: Oesophageal Cancer -- Gastric Cancer; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2012-303008
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Objective: This study assessed the associations between hospital volume, resection rate and survival of oesophageal and gastric cancer patients in England. Design: 62 811 patients diagnosed with oesophageal or gastric cancer between 2004 and 2008 were identified from a national population-based cancer registration and Hospital Episode Statistics-linked dataset. Cox regression analyses were used to assess all-cause mortality according to hospital volume and resection rate, adjusting for case-mix variables (sex, age, socioeconomic deprivation, comorbidity and type of cancer). HRs and 95% CIs, according to hospital volume, were evaluated for three predefined periods following surgery: <30, 30–365, and >365 days. Analysis of mortality in relation to resection rate was performed among all patients and among the 13 189 (21%) resected patients. Results: Increasing hospital volume was associated with lower mortality (ptrend =0.0001; HR 0.87, 95% CI 0.79 to 0.95 for hospitals resecting 80+ and compared with <20 patients a year). In relative terms, the association between increasing hospital volume and lower mortality was particularly strong in the first 30 days following surgery (ptrend <0.0001; HR 0.52, (0.39 to 0.70)), but a clinically relevant association remained beyond 1 year (ptrend =0.0011; HR 0.82, (0.72 to 0.95)). Increasing resection rates were associated with lower mortality among all patients (ptrend <0.0001; HR 0.86, (0.84 to 0.89) for the highest, compared with the lowest resection quintile). Conclusions: With evidence of lower short-term and longer-term mortality for patients resected in high-volume hospitals, this study supports further centralisation of oesophageal and gastric cancer surgical services in England.