Overall Volume Trends in Esophageal Cancer Surgery Results From the Dutch Upper Gastrointestinal Cancer Audit. Issue 3 (September 2021)

• Record Type: Journal Article
• Authors: Voeten, Daan M.; Gisbertz, Suzanne S.; Ruurda, Jelle P.; Wilschut, Janneke A.; Ferri, Lorenzo E.; van Hillegersberg, Richard; van Berge Henegouwen, Mark I.
• Is Part Of: Annals of surgery. Volume 274:Issue 3(2021)
• Publication Date: 2021-09
• Subjects: centralization -- esophageal cancer -- esophagectomy -- hospital volume; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000004985
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: In the pursuit of quality improvement, this study aimed to investigate volume-outcome trends in oncologic esophagectomy in the Netherlands. Summary of Background Data: Concentration of Dutch esophageal cancer care was dictated by introducing an institutional minimum of 20 resections/yr. Methods: This nationwide cohort study included all esophagectomy patients registered in the Dutch Upper Gastrointestinal Cancer Audit in 2016–2019 from hospitals currently still performing esophagectomies. Annual esophagectomy hospital volume was assigned to each patient and categorized into quartiles. Multivariable logistic regression investigated short-term surgical outcomes. Restricted cubic splines investigated if volume-outcome relationships eventually plateaued. Results: In 16 hospitals, 3135 esophagectomies were performed. First volume quartile hospitals performed 24–39 resections/yr; second, third, and fourth quartile hospitals performed 40–53, 54–69, and 70–101, respectively. Compared to quartile 1, in quartiles 2 to 4, overall/severe/technical complication, anastomotic leakage, and prolonged hospital/intensive care unit stay rates were significantly lower and textbook outcome and lymph node yield were higher. When raising the cut-off from the first to second quartile, higher-volume centers had less technical complications [Adjusted odds ratio (aOR): 0.82, 95% confidence interval (CI): 0.70–0.96], less anastomotic leakage (aOR: 0.80, 95% CI: 0.66–0.97), more textbook outcome (aOR: 1.25, 95% CI: 1.07–1.46), shorter intensive care unit stay (aOR: 0.80, 95% CI: 0.69–0.93), and higher lymph node yield (aOR: 3.56, 95% CI: 2.68–4.77). For most outcomes the volume-outcome trend plateaued at 50–60 annual resections, but lymph node yield and anastomotic leakage continued to improve. Conclusion: Although this study does not reflect on individual hospital quality, there appears to be a volume trend towards better outcomes in high-volume centers. Projects have been initiated to improve national quality of care by reducing hospital variation (irrespective of volume) in outcomes in The Netherlands. Abstract : Supplemental Digital Content is available in the text