What is known?
Research studies published internationally recommend centralising gastric cancer surgery, so that these surgical procedures are all carried out in a small number of “high volume” hospitals leading to better surgical outcomes. However, these international studies use a definition of “high volume” that is much higher than those relevant in most major hospital centres in Australia and New Zealand. Given the lack of Australian-specific data on differences between total and partial gastrectomy, this study assessed the impact of resection volume and service capability on operative mortality, morbidity and surgical quality in gastric cancer patients who had a partial and total gastrectomy.
What is new?
There were 426 patients who had a total gastrectomy and 827 having partial gastrectomy in Queensland between 2001 and 2015. About two-thirds (67%) of the total gastrectomy procedures and over half (59%) of the partial gastrectomy procedures were carried out in hospitals with high volume and high service capacity.
For partial gastrectomy procedures, hospitals with high volume and high service capacity had higher surgical quality rates, while surgical complications were highest in hospitals with low volume and low service capacity. There was no difference in 30-day-mortality nor in failure-to-rescue.
For total gastrectomy procedures, hospitals with high volume and high service capacity had lower 30-day-mortality and failure-to-rescue rates. There was no difference in operative morbidity and surgical quality between hospital groups.
What does this mean?
Despite the “high volume” threshold for gastrectomy in Australia being the lowest described in the literature, we have shown that centralisation to hospital centres that were high volume and high service capacity was associated with lower operative mortality for total gastrectomy and improved quality of surgery for partial gastrectomy.
Contact: Peter Baade
Reference: Tian K, Baade P, Aitken J, Narendra A, Smithers M. Procedure-specific outcomes following gastrectomy for cancer compared by hospital-volume and service-capability. ANZ Journal of Surgery. 2021. doi: 10.1111/ans.17132.