title: Hospital volume, proportion resected and mortality from oesophageal and gastric cancer: a population-based study in England, 2004-2008.
abstract: OBJECTIVE
  This study assessed the associations between hospital volume, resection rate and survival of oesophageal and gastric cancer patients in England.
  
  
  METHODS
  62,811 patients diagnosed with oesophageal or gastric cancer between 2004 and 2008 were identified from a national population-based cancer registration and Hospital Episode Statistics-linked dataset. Cox regression analyses were used to assess all-cause mortality according to hospital volume and resection rate, adjusting for case-mix variables (sex, age, socioeconomic deprivation, comorbidity and type of cancer). HRs and 95% CIs, according to hospital volume, were evaluated for three predefined periods following surgery: <30, 30-365, and >365 days. Analysis of mortality in relation to resection rate was performed among all patients and among the 13 189 (21%) resected patients.
  
  
  RESULTS
  Increasing hospital volume was associated with lower mortality (p trend=0.0001; HR 0.87, 95% CI 0.79 to 0.95 for hospitals resecting 80+ and compared with <20 patients a year). In relative terms, the association between increasing hospital volume and lower mortality was particularly strong in the first 30 days following surgery (p trend<0.0001; HR 0.52, (0.39 to 0.70)), but a clinically relevant association remained beyond 1 year (p trend=0.0011; HR 0.82, (0.72 to 0.95)). Increasing resection rates were associated with lower mortality among all patients (p trend<0.0001; HR 0.86, (0.84 to 0.89) for the highest, compared with the lowest resection quintile).
  
  
  CONCLUSIONS
  With evidence of lower short-term and longer-term mortality for patients resected in high-volume hospitals, this study supports further centralisation of oesophageal and gastric cancer surgical services in England.
authors.affiliation: King's College London, Thames Cancer Registry, 42, Weston Street, London SE1 3QD, UK. victoria.coupland@kcl.ac.uk
authors.forename: Victoria H
authors.initials: VH
authors.lastname: Coupland
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
authors.forename: Margreet
authors.initials: M
authors.lastname: Lüchtenborg
authors.forename: Ruth H
authors.initials: RH
authors.lastname: Jack
authors.forename: William
authors.initials: W
authors.lastname: Allum
authors.forename: Lars
authors.initials: L
authors.lastname: Holmberg
authors.forename: George B
authors.initials: GB
authors.lastname: Hanna
authors.forename: Neil
authors.initials: N
authors.lastname: Pearce
authors.forename: Henrik
authors.initials: H
authors.lastname: Møller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D005743:Gastrectomy / Q000401:mortality / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012042:Registries; D020379:Risk Adjustment; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
keywords: Gastric Cancer; Oesophageal Cancer