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Surgical Endoscopy

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01-04-2014

Endoscopic submucosal dissection for gastric cancer: the influence of hospital volume on complications and length of stay

Authors: Atsuhiko Murata, Kohji Okamoto, Keiji Muramatsu, Shinya Matsuda

Published in: Surgical Endoscopy | Issue 4/2014

Abstract

Background

Little information is available about the relationship between hospital volume and the clinical outcome of endoscopic submucosal dissection (ESD) for gastric cancer. The purpose of this study was to investigate the influence of hospital volume on clinical outcomes of ESD using a national administrative database.

Methods

A total of 27,385 patients treated with ESD for gastric cancer were referred to 867 hospitals between 2009 and 2011 in Japan. We collected patients’ data from the administrative database to compare ESD-related complications and length of stay (LOS) in relation to hospital volume. Hospital volume was categorized into three groups based on the number of cases treated over the study period: low-volume hospitals (LVHs, <50 cases), medium-volume hospitals (MVHs, 50–100 cases), and high-volume hospitals (HVHs, >100 cases). These analyses were performed for each location of gastric cancer [upper (cardia and fundus), middle (body), and lower third (antrum and pylorus)].

Results

Significant differences in ESD-related complications among the three hospital volume categories were observed for upper gastric cancer (6.5 % in LVHs vs. 5.2 % in MVHs vs. 3.4 % in HVHs; p = 0.017). Multiple logistic regression revealed that HVHs were significantly associated with decreased relative risk of ESD-related complications in upper gastric cancer (odds ratio for HVHs 0.51; 95 % confidence interval, 0.31–0.83, p = 0.007). However, no significant differences for ESD-related complications were seen for middle and lower gastric cancers among the different hospital volume categories (p > 0.05). Additionally, hospital volume was significantly associated with a decreasing LOS for all locations of gastric cancers (p < 0.001).

Conclusions

The present study has demonstrated that hospital volume was mainly associated with clinical outcome in patients with ESD for upper gastric cancer. Further studies for successive monitoring of outcomes of ESD should be conducted in the near future.

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Title: Endoscopic submucosal dissection for gastric cancer: the influence of hospital volume on complications and length of stay
Authors: Atsuhiko Murata
Kohji Okamoto
Keiji Muramatsu
Shinya Matsuda
Publication date: 01-04-2014
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 4/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-3326-4

At a glance: The STEP trials

Springer Medicine

Endoscopic submucosal dissection for gastric cancer: the influence of hospital volume on complications and length of stay

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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