Surgeon's Experience Overrides the Effect of Hospital Volume for Postoperative Outcomes of Laparoscopic Surgery in Gastric Cancer: Multi-institutional Study.
BACKGROUND
Hospital volume is known to be a crucial factor in reducing postoperative morbidity and mortality in laparoscopic gastrectomy for gastric cancer. However, it is unclear whether surgeon's individual experience can overcome the effect of hospital volume.


METHODS
Clinicopathologic data of initial 50 laparoscopic gastrectomy cases were collected from six gastric cancer surgeons. Half of the six surgeons worked in high-volume centers, and the other half worked in low-volume hospitals. Perioperative outcomes were compared between the high-volume centers and the low-volume hospitals.


RESULTS
Three low-volume hospitals in this study contained significantly more male and older patients with a higher American Society of Anesthesiologists score than high-volume centers. Although high- and low-volume hospitals mainly used laparoscopy-assisted and totally laparoscopic approach, respectively, there were no differences between the two groups in the extent of resection, operating time, estimated blood loss, and number of collected lymph nodes. Postoperative recovery such as duration to soft diet and hospital stay did not differ between the high- and the low-volume hospitals. No significant difference was found in postoperative morbidities by Clavien-Dindo classification. There was no mortality reported in both groups of the enrolled hospitals.


CONCLUSIONS
Hospital volume is not a decisive factor in affecting postoperative morbidity and mortality for well-trained beginners in laparoscopic surgery for gastric cancer.
Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Han Hong
HH
Lee
Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
Sang-Yong
SY
Son
Department of Surgery, Hanyang University Hospital, Hanyang University School of Medicine, Seoul, Korea.
Ju Hee
JH
Lee
Department of Surgery, Hanyang University Guri Hospital, Hanyang University School of Medicine, Seoul, Korea.
Min Gyu
MG
Kim
Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
Hoon
H
Hur
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea. djpark@snubh.org.
Do Joong
DJ
Park
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002983:Clinical Competence; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D013274:Stomach Neoplasms / Q000601:surgery*