The volume‐outcome relation in the surgical treatment of esophageal cancer
Open Access
- 25 August 2011
- Vol. 118 (7), 1754-1763
- https://doi.org/10.1002/cncr.26383
Abstract
This study was undertaken to conduct a systematic review and meta‐analysis of the literature on the relation between procedural volume and outcome of esophagectomies. A systematic search was carried out to identify articles investigating effects of hospital or surgeon volume on short‐term and long‐term outcomes published between 1995 and 2010. Articles were scrutinized for methodological quality, and after inclusion of only high‐quality studies, a meta‐analysis assuming a random effects model was done to estimate the effect of higher volume on patient outcome. Heterogeneity in study results was evaluated with an I2‐test and risk of publication bias with an Egger regression intercept. Forty‐three studies were found. Sixteen studies met the strict inclusion criteria for the meta‐analysis on hospital volume and postoperative mortality and 4 studies on hospital volume and survival. The pooled estimated effect size was significant for high‐volume providers in the analysis of postoperative mortality (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.89‐2.80) and in the survival analysis (OR, 1.17; 95% CI, 1.05‐1.30). The meta‐analysis of surgical volume and outcome showed no significant results. Studies in which the results were adjusted not only for patient characteristics but also for tumor characteristics and urgency of the operation showed a stronger correlation between hospital volume and mortality. Also, studies performed on data from the United States showed higher effect sizes. The evidence for hospital volume as an important determinant of outcome in esophageal cancer surgery is strong. Concentration of procedures in high‐volume hospitals with a dedicated setting for the treatment of esophageal cancer might lead to an overall improvement in patient outcome. Cancer 2012;. © 2011 American Cancer Society.Keywords
This publication has 60 references indexed in Scilit:
- The quality of cancer care initiative in the NetherlandsEuropean Journal of Surgical Oncology, 2010
- Outcome of Low-Volume Surgery for Esophageal Cancer in a High-Volume Referral CenterAnnals of Surgical Oncology, 2009
- Effects of hospital and surgeon case-volumes on postoperative complications and length of stay after esophagectomy in JapanSurgery Today, 2009
- The effect of volume on esophageal cancer resections: What constitutes acceptable resection volumes for centers of excellence?The Journal of Thoracic and Cardiovascular Surgery, 2009
- High-Volume versus Low-Volume for Esophageal Resections for Cancer: The Essential Role of Case-Mix Adjustments based on Clinical DataAnnals of Surgical Oncology, 2007
- Specificity of Procedure Volume and In-hospital Mortality AssociationAnnals of Surgery, 2007
- Hospital Volume and Late Survival After Cancer SurgeryAnnals of Surgery, 2007
- Better Survival in Patients with Esophageal Cancer After Surgical Treatment in University Hospitals: A Plea for Performance by Surgical OncologistsAnnals of Surgical Oncology, 2007
- Measuring inconsistency in meta-analysesBMJ, 2003
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002