Procedure volume of gastric cancer resections versus 5-year survival.
OBJECTIVE
We used nationwide, population-based data to examine associations between hospital and surgeon volumes of gastric cancer resections and their patients' short-term and long-term survival likelihood.


METHODS
The study uses 1997-1999 inpatient claims data from Taiwan's National Health Insurance linked to "cause of death" data for 1997-2004. The total cohort of 6909 gastric cancer resection patients were categorized by their surgeon's/hospital's procedure volume, and examined for differences in 6-month mortality and 5-year mortality (post 6 months), by procedure volume, using Cox proportional hazard regressions, adjusting for surgeon, hospital and patient characteristics. We hypothesized that surgeons' case volume and age but not hospital volume will predict short-term and long-term survival.


RESULTS
Adjusted estimates show that increasing surgeon volume predicts better 6-month survival (adjusted mortality hazard ratio = 1.3 for low-volume surgeons relative to very high-volume surgeons; p < 0.01) and 5-year survival (adjusted mortality hazard ratios = 1.3; p < 0.001 for low-volume; 1.2 with p < 0.01 for medium volume) and increasing surgeon's age (adjusted hazards ratio = 1.4 for age < 41 years relative to 41-50 years; p < or = 0.001; 0.8 for > or = 51 years relative to 41-50 years; p < 0.05). In hospital volume regressions, surgeon's age is a consistent and significant predictor, not hospital volume. Findings suggest a key role of experience in surgical skill and sensitivity for early stage diagnosis in gastric cancer survival.


CONCLUSIONS
Although a key study limitation is the lack of cancer stage data, the pattern of findings suggests that experienced surgeons have relatively better survival outcomes among gastric cancer patients.
Xirasagar
S
S
Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA.
Lien
Y C
YC
Lin
H C
HC
Lee
H C
HC
Liu
T C
TC
Tsai
J
J
D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate; D013624:Taiwan; D013997:Time Factors