title: Hospital volume does not influence long-term survival of patients undergoing surgery for oesophageal or gastric cancer.
abstract: BACKGROUND
  Guidelines suggest that surgery for oesophageal and gastric cancer should be conducted in large cancer centres. This national study examined the relationship between hospital volume and outcome in Scotland.
  
  
  METHODS
  This was a prospective, population-based study of 3293 consecutive patients with oesophageal or gastric cancer diagnosed between 1997 and 1999. Some 1302 patients underwent surgery and were followed for 5 years after operation.
  
  
  RESULTS
  The 5-year adjusted overall survival rate for the 3293 patients was 18.7 (95 per cent confidence interval (c.i.) 17.2 to 20.2) per cent and that after surgical resection was 39.6 (95 per cent c.i. 36.3 to 43.0) per cent. Death within 1 year after surgical resection was associated with a postoperative complication (odds ratio (OR) 2.5 (95 per cent c.i. 1.6 to 3.8); P < 0.001) or resection margin involvement by tumour (OR 7.2 (95 per cent c.i. 1.1 to 47.5); P = 0.042) after adjustment for age, sex and tumour location. There was no relationship between hospital volume and postoperative morbidity or mortality, nor between survival and volume of patients either for hospital of diagnosis or hospital of surgery.
  
  
  CONCLUSIONS
  This population-based study of oesophageal and gastric cancer suggests that the link between hospital volume and long-term survival for patients undergoing surgery requires re-evaluation.
authors.affiliation: Department of Surgery and Molecular Oncology, University of Dundee, Dundee, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Thompson
authors.forename: T
authors.initials: T
authors.lastname: Rapson
authors.forename: F J
authors.initials: FJ
authors.lastname: Gilbert
authors.forename: K G M
authors.initials: KG
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012606:Scotland; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome