Volume 201 - Issue 8
Survival, mortality and morbidity outcomes after oesophagogastric cancer surgery in New South Wales, 2001–2008
Authors: Nicola Creighton, Ross C Smith and David C Currow
Med J Aust 2014; 201 (8): 447. || doi: 10.5694/mja14.00975
Published online: 20 October 2014
Published online: 20 October 2014
In reply: Does institutional volume matter?
In reply: International evidence of high-volume institutions having better outcomes for complex cancer surgery is strong.1,2 Our analyses confirm the direction and magnitude of this relationship in New South Wales. Should we ignore the international evidence?
Our analyses showed improved 5-year survival for people with oesophagogastric cancer who received surgery in a higher-volume hospital. The difference in survival was not explained by the age, comorbidity, extent of disease or urgency of admission. We used hospital volume as a measure of hospital experience in the surgical and non-surgical management of oesophagogastric cancer patients. More accurate staging and more effective delivery of adjuvant therapy may be part of the reason for the volume–outcome relationships observed. Patient outcomes are determined by more than what happens on the operating table. This is not about the surgeon but about performing complex procedures frequently enough in institutions able to provide the range of diagnostics, perioperative support services, multidisciplinary care and expertise that surgeons require and patients need for great outcomes.3,4 Can anyone defend institutions performing these procedures at a low volume?
Competing interests
No relevant disclosures.
References
- Wouters MW, Gooiker GA, van Sandick JW, Tollenaar RA. The volume–outcome relation in the surgical treatment of esophageal cancer: a systematic review and meta-analysis. Cancer 2012; 118: 1754-1763. 1
- Pieper D, Mathes T, Neugebauer E, Eikermann M. State of evidence on the relationship between high-volume hospitals and outcomes in surgery: a systematic review of systematic reviews. J Am Coll Surg 2013; 216: 1015-1025. 2
- Australia and New Zealand Gastric and Oesophageal Surgery Association. ANZGOSA guidelines for hospitals and/or health services to assist in credentialing of surgeons performing oesophageal resection in Australia and New Zealand 2013. Adelaide: ANZGOSA, 2013. http://www.anzgosa.org/pdf/guidelines-to-performing-oesophagea-resection.pdf (accessed Jul 2014).
- Padbury RTA. Survival from pancreatic cancer: it's not just about the surgical mortality [editorial]. Med J Aust 2012; 196: 491-492. lefthere