Some studies using registry data have suggested a long-term survival advantage after curative surgical resection of gastric cancer at hospitals where surgery volume is high.
Such data may be significantly influenced by the impact of postoperative mortality and may be imbalanced for factors important to survival.
However, the true nature of this relationship remains uncertain.
|High-volume centers had a hazard ratio of 0.8 for overall survival|
|Annals of Surgery|
Dr Peter Enzinger and colleagues conducted a nested volume-outcome study in a sample of 448 surgical survivors with gastric and gastroesophageal junction Aden carcinoma.
The patients were previously randomized to adjuvant chemoradiation after surgery or surgery alone.
The research team measured the effect of hospital surgical volume, as assessed by Medicare claims data, on overall survival and gastric cancer recurrence.
The researchers found in that hospital surgical volume was not predictive of overall survival or disease-free survival at a median follow-up of 9 years.
However, patients who underwent either a D1 or D2 dissection at a high- or moderate-volume center experienced an adjusted hazard ratio of 0.8 for overall survival.
The team noted that patients who underwent a D1 or D2 dissection at higher volume centers also had an adjusted hazard ratio of about 0.8 for disease-free survival.
When a D0 resection was performed, hospital procedure volume showed no impact on survival.
Dr Enzinger's team concluded, “Excluding the impact of perioperative mortality by utilizing prospectively recorded data from a large postoperative adjuvant trial, hospital procedure volume had no overall effect on long-term gastric cancer survival.”
“The potential benefit of moderate- to high-volume centers for patients who underwent a D1 or D2 dissection requires confirmation in larger studies.”