title: Impact of hospital volume on long-term survival after resection for oesophageal cancer: a population-based study in Taiwan†.
abstract: OBJECTIVE
  Previous studies have shown that patients who undergo oesophageal cancer surgery in high-volume hospitals have lower postoperative mortality rates. However, the impact of hospital volume on long-term survival is controversial.
  
  
  METHODS
  We identified 2151 patients who were diagnosed with oesophageal cancer between 2008 and 2011 from a national population-based cancer registry in Taiwan. High-volume hospitals were defined as those performing more than 86 oesophagectomies during that period (22 cases/year). Patients were stratified by whether they received preoperative chemoradiation. Cox regression analyses were used to determine the survival impact of hospital volume.
  
  
  RESULTS
  The 3-year overall survival rates after oesophagectomies were 44.9% in high-volume hospitals, compared with 40.2% in low-volume hospitals (P = 0.002). For patients who received preoperative chemoradiation (n = 850), the 1- and 3-year overall survival rates were 74.7 and 36.8%, respectively, in high-volume hospitals, compared with 73.5 and 42.6%, respectively, in low-volume hospitals (P = 0.333). For patients who did not receive preoperative chemoradiation (n = 1301), the 1- and 3-year overall survival rates were 78.1 and 50.0%, respectively, in high-volume hospitals, compared with 67.9 and 38.8%, respectively, in low-volume hospitals (P < 0.001). Multivariate analysis showed that hospital volume, resection margin, cT, pT and pN stages are significant independent prognostic factors.
  
  
  CONCLUSIONS
  Overall survival rate of patients who undergo oesophagectomies without preoperative chemoradiation at high-volume hospitals is significantly higher than at low-volume hospitals. However, there was no significant correlation between hospital volume and long-term outcome in patients who received preoperative chemoradiation.
authors.affiliation: Division of Chest Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Po-Kuei
authors.initials: PK
authors.lastname: Hsu
authors.affiliation: Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hui-Shan
authors.initials: HS
authors.lastname: Chen
authors.affiliation: Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shiao-Chi
authors.initials: SC
authors.lastname: Wu
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Taichung, Taiwan.
authors.forename: Bing-Yen
authors.initials: BY
authors.lastname: Wang
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Chao-Yu
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Chih-Hsun
authors.initials: CH
authors.lastname: Shih
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan gcliu@kfsyscc.org.
authors.forename: Chia-Chuan
authors.initials: CC
authors.lastname: Liu
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D016629:Esophagectomy / Q000401:mortality* / Q000706:statistics & numerical data*; D005260:Female; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology
keywords: Cancer registry; Hospital volume; Oesophageal cancer; Oesophagectomy; Survival