Improved survival after esophageal cancer surgery in Sweden during recent years may be attributable to the increased centralization of such surgery.
Dr Ioannis Rouvelas and colleagues identified all Swedish residents undergoing esophageal cancer surgery from 1987 through 2000.
The research team followed up inpatient and cancer registers until 2004, through nationwide registers.
|30-day survival was 96% at high-volume hospitals|
|Achives of Surgery |
Hospital, tumor, and patient characteristics and preoperative oncological treatment were assessed through the registers and histopathological records.
Among 4904 patients with esophageal cancer, 1199 patients who underwent resection constituted the study cohort.
The team's main outcome measure was survival rates and hazard ratios relative to hospital volume.
The team noted that low-volume hospitals conducted fewer than 10 esophagectomies annually, while high-volume hospitals conducted 10 or more.
Hazard ratios were adjusted for several potential confounders.
The researchers noticed that 30-day survival was 96% at high-volume hospitals, and 91% at low-volume hospitals.
The team observed that survival rates at 1, 3, and 5 years after surgery at high-volume hospitals were 58%, 35%, and 27%, respectively.
The team noted that survival rates at 1,3, and 5 years after surgery at low-volume hospitals were 55%, 30%, and 24%, respectively.
The adjusted hazard ratio was nonsignificantly decreased by 10% at high-volume hospitals.
In an analysis restricted to 764 patients without preoperative oncological treatment, survival was similar at high-volume hospitals and at low-volume hospitals.
Dr Rouvelas' team concluded, “This study revealed no effect of hospital volume on long-term survival after esophageal cancer surgery.”
“Tumor biology apparently has a greater effect on the chances of long-term survival than hospital volume.”