The influence of case load and the extent of resection on the quality of treatment outcome in gastric cancer.
OBJECTIVE
The background was to analyse the influence of hospital- and surgeon volume and of the extent of resective procedures on the quality of early and late treatment results in gastric cancer.


METHODS
The literature was reviewed by searching the databases of Medline, Cancerlit, Pubmed and the Cochran register.


RESULTS
The levels of evidence showed wide variations. The influence of hospital volume was more important for the outcome than the case load of the individual surgeon. The extent of surgical resection should be adapted to histology--or stage. The value of systematic lymph node dissection is still under discussion.


CONCLUSIONS
We have found that the best treatment results were seen in high volume hospitals with experienced surgeons, even taking into account extended surgical procedures. Further studies are needed to define the optimal number of operations necessary to be carried out each year.
Meyer
H-J
HJ
Department of General and Visceral Surgery, Städtisches Klinikum Solingen, 42653 Solingen, Germany. meyer@klinikumsolingen.de
D002986:Clinical Trials as Topic; D005743:Gastrectomy / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011787:Quality of Health Care; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D013503:Surgery Department, Hospital / Q000592:standards* / Q000706:statistics & numerical data*; D015996:Survival Rate; D016896:Treatment Outcome