Centralization of healthcare, especially for advanced cancer surgery, has been a matter of debate.
Clear short-term mortality benefits have been described for esophageal cancer surgery conducted at high-volume hospitals, and by high-volume surgeons.
Dr Nele Brusselaers and colleagues from Sweden clarified the association between hospital volume, surgeon volume and hospital type in relation to long-term survival after esophagectomy for cancer, by a meta-analysis.
The systematic literature search included PubMed, Web of Science, Cochrane library, EMBASE and Science Citation Index, for the period 1990–2013.
|16 studies from 7 countries met the inclusion criteria|
Eligible articles were those which reported survival (time to death) as HRs after esophagectomy for cancer by hospital volume, surgeon volume or hospital type.
The team's main outcomes included fully adjusted hazard ratios for the longest follow-up.
The research team identified 16 studies from 7 countries that met the inclusion criteria.
The team noted that these studies reported hospital volume, surgeon volume or hospital type.
The researchers found a survival benefit for high-volume hospitals, and possibly also, for high-volume surgeons compared with their low-volume counterparts.
The team observed no association with survival remained for hospital volume after adjustment for surgeon volume.
A survival benefit was found in favor of high-volume surgeons after adjustment for hospital volume.
Dr Brusselaers' team concludes, "This meta-analysis demonstrated better long-term survival after esophagectomy with high-volume surgery, and surgeon volume might be more important than hospital volume."
"These findings support centralization with fewer surgeons working at large centers."