Impact of Hospital Volume on Long-term Survival After Esophageal Cancer Surgery
HYPOTHESIS The improved survival after esophageal cancer surgery in Sweden during recent years may be attributable to the increased centralization of such surgery. DESIGN Population-based study. SETTING All Swedish residents undergoing esophageal cancer surgery from January 1, 1987, through December...
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| Veröffentlicht in: | Archives of surgery (Chicago. 1960) 2007-02, Vol.142 (2), p.113-117 |
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| creator | Rouvelas, Ioannis Lindblad, Mats Zeng, Wenyi Viklund, Pernilla Ye, Weimin Lagergren, Jesper |
| description | HYPOTHESIS The improved survival after esophageal cancer surgery in Sweden during recent years may be attributable to the increased centralization of such surgery. DESIGN Population-based study. SETTING All Swedish residents undergoing esophageal cancer surgery from January 1, 1987, through December 31, 2000, were identified from the inpatient and cancer registers and were followed up until October 18, 2004, through nationwide registers. Hospital, tumor, and patient characteristics and preoperative oncological treatment were assessed through the registers and histopathological records. PATIENTS Among 4904 patients with esophageal cancer, 1199 patients (24.4%) who underwent resection constituted the study cohort. MAIN OUTCOME MEASURE Survival rates and hazard ratios (HRs) relative to hospital volume. Low-volume hospitals (LVHs) conducted fewer than 10 esophagectomies annually, while high-volume hospitals (HVHs) conducted 10 or more. Hazard ratios were adjusted for several potential confounders. RESULTS Thirty-day survival was 96% at HVHs and 91% at LVHs (P = .09). Survival rates 1, 3, and 5 years after surgery at HVHs were nonsignificantly higher (58%, 35%, and 27%, respectively) compared with those at LVHs (55%, 30%, and 24%, respectively). The adjusted HR was nonsignificantly 10% decreased at HVHs (HR, 0.90; 95% confidence interval, 0.79-1.04). In an analysis restricted to 764 patients (64%) without preoperative oncological treatment (in which the tumor stage was also adjusted for), survival was similar at HVHs and at LVHs (HR, 0.99; 95% confidence interval, 0.84-1.18). CONCLUSIONS 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.Arch Surg. 2007;142:113-117--> |
| doi_str_mv | 10.1001/archsurg.142.2.113 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_571550</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>399806</ama_id><sourcerecordid>1222174251</sourcerecordid><originalsourceid>FETCH-LOGICAL-a458t-246108f752ff99e7167e83e62f9e6fff26a40881899a9309ea89daa538dd804c3</originalsourceid><addsrcrecordid>eNpdkU1P3DAQhq2qqGyhPwAOKEJqb1n8HfuIVlCQVuLQ0qs1ZO0lkMSpnYD49wzaFKSePH7nmRmPX0KOGV0yStkZpPo-T2m7ZJIv-ZIx8YksmBKmFFrKz2RBKZUlknSffM35ASNuLP9C9lklqLWaLcjNdTdAPRYxFFcxD80IbfEntlPni9gX69hvy9Gnrvg1pafmCZPnAe_FRY7DPWw9Civoa1QQ2Pr0ckj2ArTZf5vPA3J7efF7dVWub35er87XJUhlxpJLzagJleIhWOsrpitvhNc8WK9DCFyDpMYwYy1YfKsHYzcAuNtmY6isxQEpd33zsx-mOzekpoP04iI0bpYeMfJOVUwpivyPHT-k-HfyeXRdk2vfttD7OGWnLRWcVhzB0__AhzilHndxXHClhJQaIb6D6hRzTj68z2fUvXnj_nnj0BvHHXqDRSdz5-mu85uPktkMBL7PAOQa2pDwZ5v8wRnFqFUGuaMdBx28Z4W1hmrxCo7woJg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>232553446</pqid></control><display><type>article</type><title>Impact of Hospital Volume on Long-term Survival After Esophageal Cancer Surgery</title><source>MEDLINE</source><source>American Medical Association Journals</source><source>Alma/SFX Local Collection</source><creator>Rouvelas, Ioannis ; Lindblad, Mats ; Zeng, Wenyi ; Viklund, Pernilla ; Ye, Weimin ; Lagergren, Jesper</creator><creatorcontrib>Rouvelas, Ioannis ; Lindblad, Mats ; Zeng, Wenyi ; Viklund, Pernilla ; Ye, Weimin ; Lagergren, Jesper</creatorcontrib><description>HYPOTHESIS The improved survival after esophageal cancer surgery in Sweden during recent years may be attributable to the increased centralization of such surgery. DESIGN Population-based study. SETTING All Swedish residents undergoing esophageal cancer surgery from January 1, 1987, through December 31, 2000, were identified from the inpatient and cancer registers and were followed up until October 18, 2004, through nationwide registers. Hospital, tumor, and patient characteristics and preoperative oncological treatment were assessed through the registers and histopathological records. PATIENTS Among 4904 patients with esophageal cancer, 1199 patients (24.4%) who underwent resection constituted the study cohort. MAIN OUTCOME MEASURE Survival rates and hazard ratios (HRs) relative to hospital volume. Low-volume hospitals (LVHs) conducted fewer than 10 esophagectomies annually, while high-volume hospitals (HVHs) conducted 10 or more. Hazard ratios were adjusted for several potential confounders. RESULTS Thirty-day survival was 96% at HVHs and 91% at LVHs (P = .09). Survival rates 1, 3, and 5 years after surgery at HVHs were nonsignificantly higher (58%, 35%, and 27%, respectively) compared with those at LVHs (55%, 30%, and 24%, respectively). The adjusted HR was nonsignificantly 10% decreased at HVHs (HR, 0.90; 95% confidence interval, 0.79-1.04). In an analysis restricted to 764 patients (64%) without preoperative oncological treatment (in which the tumor stage was also adjusted for), survival was similar at HVHs and at LVHs (HR, 0.99; 95% confidence interval, 0.84-1.18). CONCLUSIONS 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.Arch Surg. 2007;142:113-117--></description><identifier>ISSN: 0004-0010</identifier><identifier>ISSN: 2168-6254</identifier><identifier>EISSN: 1538-3644</identifier><identifier>EISSN: 2168-6262</identifier><identifier>DOI: 10.1001/archsurg.142.2.113</identifier><identifier>PMID: 17309961</identifier><identifier>CODEN: ARSUAX</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Adenocarcinoma - mortality ; Adenocarcinoma - pathology ; Adenocarcinoma - surgery ; Aged ; Biological and medical sciences ; Cancer surgery ; Carcinoma, Squamous Cell - mortality ; Carcinoma, Squamous Cell - pathology ; Carcinoma, Squamous Cell - surgery ; Clinical outcomes ; Esophageal Neoplasms - mortality ; Esophageal Neoplasms - pathology ; Esophageal Neoplasms - surgery ; Esophagectomy ; Esophagus ; Female ; Follow-Up Studies ; Gastroenterology. Liver. Pancreas. Abdomen ; General aspects ; Hospitals ; Hospitals, University - statistics & numerical data ; Humans ; Male ; Medical sciences ; Middle Aged ; Oncology ; Population Surveillance ; Postoperative Period ; Retrospective Studies ; Survival Rate - trends ; Sweden - epidemiology ; Treatment Outcome ; Tumors ; Volume</subject><ispartof>Archives of surgery (Chicago. 1960), 2007-02, Vol.142 (2), p.113-117</ispartof><rights>2007 INIST-CNRS</rights><rights>Copyright American Medical Association Feb 2007</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a458t-246108f752ff99e7167e83e62f9e6fff26a40881899a9309ea89daa538dd804c3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamasurgery/articlepdf/10.1001/archsurg.142.2.113$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.142.2.113$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,230,314,776,780,881,3327,27901,27902,76231,76234</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18510958$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17309961$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:13955095$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Rouvelas, Ioannis</creatorcontrib><creatorcontrib>Lindblad, Mats</creatorcontrib><creatorcontrib>Zeng, Wenyi</creatorcontrib><creatorcontrib>Viklund, Pernilla</creatorcontrib><creatorcontrib>Ye, Weimin</creatorcontrib><creatorcontrib>Lagergren, Jesper</creatorcontrib><title>Impact of Hospital Volume on Long-term Survival After Esophageal Cancer Surgery</title><title>Archives of surgery (Chicago. 1960)</title><addtitle>Arch Surg</addtitle><description>HYPOTHESIS The improved survival after esophageal cancer surgery in Sweden during recent years may be attributable to the increased centralization of such surgery. DESIGN Population-based study. SETTING All Swedish residents undergoing esophageal cancer surgery from January 1, 1987, through December 31, 2000, were identified from the inpatient and cancer registers and were followed up until October 18, 2004, through nationwide registers. Hospital, tumor, and patient characteristics and preoperative oncological treatment were assessed through the registers and histopathological records. PATIENTS Among 4904 patients with esophageal cancer, 1199 patients (24.4%) who underwent resection constituted the study cohort. MAIN OUTCOME MEASURE Survival rates and hazard ratios (HRs) relative to hospital volume. Low-volume hospitals (LVHs) conducted fewer than 10 esophagectomies annually, while high-volume hospitals (HVHs) conducted 10 or more. Hazard ratios were adjusted for several potential confounders. RESULTS Thirty-day survival was 96% at HVHs and 91% at LVHs (P = .09). Survival rates 1, 3, and 5 years after surgery at HVHs were nonsignificantly higher (58%, 35%, and 27%, respectively) compared with those at LVHs (55%, 30%, and 24%, respectively). The adjusted HR was nonsignificantly 10% decreased at HVHs (HR, 0.90; 95% confidence interval, 0.79-1.04). In an analysis restricted to 764 patients (64%) without preoperative oncological treatment (in which the tumor stage was also adjusted for), survival was similar at HVHs and at LVHs (HR, 0.99; 95% confidence interval, 0.84-1.18). CONCLUSIONS 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.Arch Surg. 2007;142:113-117--></description><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cancer surgery</subject><subject>Carcinoma, Squamous Cell - mortality</subject><subject>Carcinoma, Squamous Cell - pathology</subject><subject>Carcinoma, Squamous Cell - surgery</subject><subject>Clinical outcomes</subject><subject>Esophageal Neoplasms - mortality</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophagectomy</subject><subject>Esophagus</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>General aspects</subject><subject>Hospitals</subject><subject>Hospitals, University - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Oncology</subject><subject>Population Surveillance</subject><subject>Postoperative Period</subject><subject>Retrospective Studies</subject><subject>Survival Rate - trends</subject><subject>Sweden - epidemiology</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><subject>Volume</subject><issn>0004-0010</issn><issn>2168-6254</issn><issn>1538-3644</issn><issn>2168-6262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1P3DAQhq2qqGyhPwAOKEJqb1n8HfuIVlCQVuLQ0qs1ZO0lkMSpnYD49wzaFKSePH7nmRmPX0KOGV0yStkZpPo-T2m7ZJIv-ZIx8YksmBKmFFrKz2RBKZUlknSffM35ASNuLP9C9lklqLWaLcjNdTdAPRYxFFcxD80IbfEntlPni9gX69hvy9Gnrvg1pafmCZPnAe_FRY7DPWw9Civoa1QQ2Pr0ckj2ArTZf5vPA3J7efF7dVWub35er87XJUhlxpJLzagJleIhWOsrpitvhNc8WK9DCFyDpMYwYy1YfKsHYzcAuNtmY6isxQEpd33zsx-mOzekpoP04iI0bpYeMfJOVUwpivyPHT-k-HfyeXRdk2vfttD7OGWnLRWcVhzB0__AhzilHndxXHClhJQaIb6D6hRzTj68z2fUvXnj_nnj0BvHHXqDRSdz5-mu85uPktkMBL7PAOQa2pDwZ5v8wRnFqFUGuaMdBx28Z4W1hmrxCo7woJg</recordid><startdate>20070201</startdate><enddate>20070201</enddate><creator>Rouvelas, Ioannis</creator><creator>Lindblad, Mats</creator><creator>Zeng, Wenyi</creator><creator>Viklund, Pernilla</creator><creator>Ye, Weimin</creator><creator>Lagergren, Jesper</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope></search><sort><creationdate>20070201</creationdate><title>Impact of Hospital Volume on Long-term Survival After Esophageal Cancer Surgery</title><author>Rouvelas, Ioannis ; Lindblad, Mats ; Zeng, Wenyi ; Viklund, Pernilla ; Ye, Weimin ; Lagergren, Jesper</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a458t-246108f752ff99e7167e83e62f9e6fff26a40881899a9309ea89daa538dd804c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - surgery</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cancer surgery</topic><topic>Carcinoma, Squamous Cell - mortality</topic><topic>Carcinoma, Squamous Cell - pathology</topic><topic>Carcinoma, Squamous Cell - surgery</topic><topic>Clinical outcomes</topic><topic>Esophageal Neoplasms - mortality</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophagectomy</topic><topic>Esophagus</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>General aspects</topic><topic>Hospitals</topic><topic>Hospitals, University - statistics & numerical data</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Oncology</topic><topic>Population Surveillance</topic><topic>Postoperative Period</topic><topic>Retrospective Studies</topic><topic>Survival Rate - trends</topic><topic>Sweden - epidemiology</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><topic>Volume</topic><toplevel>online_resources</toplevel><creatorcontrib>Rouvelas, Ioannis</creatorcontrib><creatorcontrib>Lindblad, Mats</creatorcontrib><creatorcontrib>Zeng, Wenyi</creatorcontrib><creatorcontrib>Viklund, Pernilla</creatorcontrib><creatorcontrib>Ye, Weimin</creatorcontrib><creatorcontrib>Lagergren, Jesper</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><jtitle>Archives of surgery (Chicago. 1960)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rouvelas, Ioannis</au><au>Lindblad, Mats</au><au>Zeng, Wenyi</au><au>Viklund, Pernilla</au><au>Ye, Weimin</au><au>Lagergren, Jesper</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Hospital Volume on Long-term Survival After Esophageal Cancer Surgery</atitle><jtitle>Archives of surgery (Chicago. 1960)</jtitle><addtitle>Arch Surg</addtitle><date>2007-02-01</date><risdate>2007</risdate><volume>142</volume><issue>2</issue><spage>113</spage><epage>117</epage><pages>113-117</pages><issn>0004-0010</issn><issn>2168-6254</issn><eissn>1538-3644</eissn><eissn>2168-6262</eissn><coden>ARSUAX</coden><abstract>HYPOTHESIS The improved survival after esophageal cancer surgery in Sweden during recent years may be attributable to the increased centralization of such surgery. DESIGN Population-based study. SETTING All Swedish residents undergoing esophageal cancer surgery from January 1, 1987, through December 31, 2000, were identified from the inpatient and cancer registers and were followed up until October 18, 2004, through nationwide registers. Hospital, tumor, and patient characteristics and preoperative oncological treatment were assessed through the registers and histopathological records. PATIENTS Among 4904 patients with esophageal cancer, 1199 patients (24.4%) who underwent resection constituted the study cohort. MAIN OUTCOME MEASURE Survival rates and hazard ratios (HRs) relative to hospital volume. Low-volume hospitals (LVHs) conducted fewer than 10 esophagectomies annually, while high-volume hospitals (HVHs) conducted 10 or more. Hazard ratios were adjusted for several potential confounders. RESULTS Thirty-day survival was 96% at HVHs and 91% at LVHs (P = .09). Survival rates 1, 3, and 5 years after surgery at HVHs were nonsignificantly higher (58%, 35%, and 27%, respectively) compared with those at LVHs (55%, 30%, and 24%, respectively). The adjusted HR was nonsignificantly 10% decreased at HVHs (HR, 0.90; 95% confidence interval, 0.79-1.04). In an analysis restricted to 764 patients (64%) without preoperative oncological treatment (in which the tumor stage was also adjusted for), survival was similar at HVHs and at LVHs (HR, 0.99; 95% confidence interval, 0.84-1.18). CONCLUSIONS 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.Arch Surg. 2007;142:113-117--></abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>17309961</pmid><doi>10.1001/archsurg.142.2.113</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adenocarcinoma - mortality Adenocarcinoma - pathology Adenocarcinoma - surgery Aged Biological and medical sciences Cancer surgery Carcinoma, Squamous Cell - mortality Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - surgery Clinical outcomes Esophageal Neoplasms - mortality Esophageal Neoplasms - pathology Esophageal Neoplasms - surgery Esophagectomy Esophagus Female Follow-Up Studies Gastroenterology. Liver. Pancreas. Abdomen General aspects Hospitals Hospitals, University - statistics & numerical data Humans Male Medical sciences Middle Aged Oncology Population Surveillance Postoperative Period Retrospective Studies Survival Rate - trends Sweden - epidemiology Treatment Outcome Tumors Volume |
| title | Impact of Hospital Volume on Long-term Survival After Esophageal Cancer Surgery |
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