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Surgeon’s Experience Overrides the Effect of Hospital Volume for Postoperative Outcomes of Laparoscopic Surgery in Gastric Cancer: Multi-institutional Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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.

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References

  1. Ecker BL, Datta J, McMillan MT, et al. Minimally invasive gastrectomy for gastric adenocarcinoma in the United States: utilization and short-term oncologic outcomes. J Surg Oncol. 2015;112:616–21.

    Article  PubMed  Google Scholar 

  2. Maduekwe UN, Yoon SS. An evidence-based review of the surgical treatment of gastric adenocarcinoma. J Gastrointest Surg. 2011;15:730–41.

    Article  PubMed  Google Scholar 

  3. Kim CH, Song KY, Park CH, Seo YJ, Park SM, Kim JJ. A comparison of outcomes of three reconstruction methods after laparoscopic distal gastrectomy. J Gastric Cancer. 2015;15:46–52.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Yoo CH, Kim HO, Hwang SI, Son BH, Shin JH, Kim H. Short-term outcomes of laparoscopic-assisted distal gastrectomy for gastric cancer during a surgeon’s learning curve period. Surg Endosc. 2009;23:2250–7.

    Article  PubMed  Google Scholar 

  5. Jung do H, Son SY, Park YS, et al. The learning curve associated with laparoscopic total gastrectomy. Gastric Cancer. 2016;19:264–72.

  6. Kim MG, Kim KC, Yook JH, Kim BS, Kim TH, Kim BS. A practical way to overcome the learning period of laparoscopic gastrectomy for gastric cancer. Surg Endosc. 2011;25:3838–44.

    Article  PubMed  Google Scholar 

  7. Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.

    Article  PubMed  Google Scholar 

  8. Dikken JL, Verheij M, Cats A, Jansen EP, Hartgrink HH, van de Velde CJ. Extended lymph node dissection for gastric cancer from a European perspective. Gastric Cancer. 2011;14:396–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kim MG, Kwon SJ. Comparison of the outcomes for laparoscopic gastrectomy performed by the same surgeon between a low-volume hospital and a high-volume center. Surg Endosc. 2014;28:1563–70.

    Article  PubMed  Google Scholar 

  10. Tokunaga M, Hiki N, Fukunaga T, et al. Learning curve of laparoscopy-assisted gastrectomy using a standardized surgical technique and an established educational system. Scand J Surg. 2011;100:86–91.

    Article  CAS  PubMed  Google Scholar 

  11. Yang SJ, Ahn EJ, Park SH, Kim JH, Park JM. The early experience of laparoscopy-assisted gastrectomy for gastric cancer at a low-volume center. J Gastric Cancer. 2010;10:241–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Murata A, Okamoto K, Muramatsu K, Matsuda S. Endoscopic submucosal dissection for gastric cancer: the influence of hospital volume on complications and length of stay. Surg Endosc. 2014;28:1298–306.

    Article  PubMed  Google Scholar 

  13. Ichikawa D, Komatsu S, Kubota T, et al. Effect of hospital volume on long-term outcomes of laparoscopic gastrectomy for clinical stage I gastric cancer. Anticancer Res. 2013;33:5165–70.

    PubMed  Google Scholar 

  14. Kim TH, Kim JJ, Kim SH, et al. Diagnostic value of clinical T staging assessed by endoscopy and stomach protocol computed tomography in gastric cancer: the experience of a low-volume institute. J Gastric Cancer. 2012;12:223–31.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  16. Brisinda G, Crocco A, Tomaiuolo P, Santullo F, Mazzari A, Vanella S. Extended or limited lymph node dissection? A gastric cancer surgical dilemma. Ann Surg. 2012;256:e30–1.

    Article  PubMed  Google Scholar 

  17. Sabesan A, Petrelli NJ, Bennett JJ. Outcomes of gastric cancer resections performed in a high volume community cancer center. Surg Oncol. 2015;24:16–20.

    Article  PubMed  Google Scholar 

  18. Dikken JL, Wouters MW, Lemmens VE, et al. Influence of hospital type on outcomes after oesophageal and gastric cancer surgery. Br J Surg. 2012;99:954–63.

    Article  CAS  PubMed  Google Scholar 

  19. Murata A, Muramatsu K, Ichimiya Y, Kubo T, Fujino Y, Matsuda S. Influence of hospital volume on outcomes of laparoscopic gastrectomy for gastric cancer in patients with comorbidity in Japan. Asian J Surg. 2015;38:33–9.

    Article  PubMed  Google Scholar 

  20. Liang Y, Wu L, Wang X, Ding X, Liang H. The positive impact of surgeon specialization on survival for gastric cancer patients after surgery with curative intent. Gastric Cancer. 2015;18:859–67.

    Article  PubMed  Google Scholar 

  21. Kim CY, Nam BH, Cho GS, et al. Learning curve for gastric cancer surgery based on actual survival. Gastric Cancer. 2016;19:631–8.

    Article  PubMed  Google Scholar 

  22. You YH, Kim YM, Ahn DH. Beginner surgeon’s initial experience with distal subtotal gastrectomy for gastric cancer using a minimally invasive approach. J Gastric Cancer. 2015;15:270–7.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nunobe S, Hiki N, Tanimura S, Nohara K, Sano T, Yamaguchi T. The clinical safety of performing laparoscopic gastrectomy for gastric cancer by trainees after sufficient experience in assisting. World J Surg. 2013;37:424–9.

    Article  PubMed  Google Scholar 

  24. Kim MC, Kim W, Kim HH, et al. Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale Korean multicenter study. Ann Surg Oncol. 2008;15:2692–700.

    Article  PubMed  Google Scholar 

  25. Fujisaki M, Shinohara T, Hanyu N, et al. Laparoscopic gastrectomy for gastric cancer in the elderly patients. Surg Endosc. 2016;30:1380–7.

    Article  PubMed  Google Scholar 

  26. Hur H, Xuan Y, Ahn CW, Cho YK, Han SU. Trends and outcomes of minimally invasive surgery for gastric cancer: 750 consecutive cases in seven years at a single center. Am J Surg. 2013;205:45–51.

    Article  PubMed  Google Scholar 

  27. Lee SE, Kim YW, Lee JH, et al. Developing an institutional protocol guideline for laparoscopy-assisted distal gastrectomy. Ann Surg Oncol. 2009;16:2231–6.

    Article  PubMed  Google Scholar 

  28. Woo J, Lee JH, Shim KN, Jung HK, Lee HM, Lee HK. Does the difference of invasiveness between totally laparoscopic distal gastrectomy and laparoscopy-assisted distal gastrectomy lead to a difference in early surgical outcomes? A prospective randomized trial. Ann Surg Oncol. 2015;22:1836–43.

    Article  PubMed  Google Scholar 

  29. Jeong O, Ryu SY, Choi WY, Piao Z, Park YK. Risk factors and learning curve associated with postoperative morbidity of laparoscopic total gastrectomy for gastric carcinoma. Ann Surg Oncol. 2014;21:2994–3001.

    Article  PubMed  Google Scholar 

  30. Kim HS, Kim SO, Kim BS. Use of a clinical pathway in laparoscopic gastrectomy for gastric cancer. World J Gastroenterol. 2015;21:13507–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. So JB, Lim ZL, Lin HA, Ti TK. Reduction of hospital stay and cost after the implementation of a clinical pathway for radical gastrectomy for gastric cancer. Gastric Cancer. 2008;11:81–5.

    Article  PubMed  Google Scholar 

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Acknowledgements

Supported in part by Grants from the National Research Foundation of Korea (2012R1A1A1043576 and 2015R1A1A1A05028000) and the Catholic Medical Center Research Foundation made in the program year of 2015.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Han Hong Lee MD

  2. Department of Surgery, Ajou University School of Medicine, Suwon, Korea

    Sang-Yong Son MD & Hoon Hur MD

  3. Department of Surgery, Hanyang University Hospital, Hanyang University School of Medicine, Seoul, Korea

    Ju Hee Lee MD

  4. Department of Surgery, Hanyang University Guri Hospital, Hanyang University School of Medicine, Seoul, Korea

    Min Gyu Kim MD

  5. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea

    Do Joong Park MD

Authors
  1. Han Hong Lee MD
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  2. Sang-Yong Son MD
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  3. Ju Hee Lee MD
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  4. Min Gyu Kim MD
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  5. Hoon Hur MD
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  6. Do Joong Park MD
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Corresponding author

Correspondence to Do Joong Park MD.

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Lee, H.H., Son, SY., Lee, J.H. et al. Surgeon’s Experience Overrides the Effect of Hospital Volume for Postoperative Outcomes of Laparoscopic Surgery in Gastric Cancer: Multi-institutional Study. Ann Surg Oncol 24, 1010–1017 (2017). https://doi.org/10.1245/s10434-016-5672-7

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  • DOI: https://doi.org/10.1245/s10434-016-5672-7

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