Outcomes After Gastric Resection
Odds of surviving gastric cancer surgery are better at hospitals that perform more gastrectomies annually.
Surgical resection is the only potentially curative option for patients with stomach cancer. To determine factors that predict patient outcomes after resection for gastric cancer, researchers evaluated data (collected from 1998 through 2003) on 13,354 patients in the Nationwide Inpatient Sample (NIS), which is the largest all-payer inpatient database in the U.S.
Overall, the in-hospital mortality rate among patients who underwent gastrectomy was 6.0%. The investigators found that a higher annual surgical volume (>11 cases) at a single hospital predicted lower in-hospital mortality; gastric cancer patients who underwent surgery at higher-volume centers had better outcomes. Significant factors that predicted in-hospital mortality included low annual hospital surgical volume (lowest [4 gastrectomies] vs. highest [11 gastrectomies], 6.8% vs. 4.9%; adjusted odds ratio [AOR], 1.5; 95% confidence interval, 1.21.8), older patient age (5069 vs. <50, 4.0% vs. 2.1%; AOR, 1.5; 95% CI, 1.12.2 and 70 vs. <50, 8.6% vs. 2.1%; AOR, 2.9; 95% CI, 2.04.3), male sex (male vs. female, 6.7% vs. 5.0%; AOR, 1.3; 95% CI, 1.11.5), and complex procedure type (total gastrectomy vs. all other resections, 8.0% vs. 5.3%; AOR, 1.4; 95% CI, 1.21.7).
Comment: These results add to a growing body of literature showing that surgical volume is directly related to patient survival and outcomes in the treatment of stomach cancer. Other factors that were significantly associated with superior outcomes after gastric resection included benign tumor diagnosis, less-complex procedure, younger age, female sex, and fewer comorbid conditions. Limitations of this study include a lack of detailed cancer staging information and no long-term survival data. Patients can improve their chances of surviving gastric cancer by choosing hospitals that perform more gastrectomies annually. These findings provide further support for volume-based referral initiatives for patients who require cancer surgery.
Henry Mark Kuerer, MD, PhD, FACS
Published in Journal Watch Oncology and Hematology May 21, 2007
Smith JK et al. National outcomes after gastric resection for neoplasm. Arch Surg 2007 Apr; 142:387-93.
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