Hospital volume and survival in oesophagectomy and gastrectomy for cancer.

BACKGROUND: High volume upper gastrointestinal cancer hospitals demonstrate improved postoperative mortality rates, but the impact on survival is unclear. This population-based cohort study explores the effect of hospital volume on survival following upper gastrointestinal cancer surgery. PATIENTS AND METHODS: This study used a population-based cohort of 3866 patients who underwent surgery for oesophageal or gastric cancer between 1998 and 2008 with follow-up until December 2008. RESULTS: Hospital volume ranged from 1 to 68 cases/year. Overall, 5-year survival was 27%. Increasing age and advanced stage of disease were independently correlated with shorter survival. High hospital volume was significantly and independently correlated with improved 30-day mortality postoperatively (P<0.001), but not with survival beyond 30 days. CONCLUSION: The correlation between hospital volume and improved 30-day mortality following oesophageal and gastric cancer surgery supports the centralisation of upper gastrointestinal cancer surgery services. The low survival in both high and low volume hospitals beyond 30 days highlights the need for increasing earlier diagnosis and optimising approaches to radical treatment.