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Journal of Gastrointestinal Surgery

, Volume 11, Issue 4, pp 410–420 | Cite as

Treatment of Gastric Adenocarcinoma May Differ Among Hospital Types in the United States, a Report from the National Cancer Data Base

  • Kaye M. Reid-LombardoEmail author
  • Greer Gay
  • Lina Patel-Parekh
  • Jaffer A. Ajani
  • John H. Donohue
  • Gastric Patient Care Evaluation Group from the Commission on Cancer
Article

Abstract

The concept that complex surgical procedures should be performed at high-volume centers to improve surgical morbidity and mortality is becoming widely accepted. We wanted to determine if there were differences in the treatment of patients with gastric cancer between community cancer centers and teaching hospitals in the United States. Data from the 2001 Gastric Cancer Patient Care Evaluation Study of the National Cancer Data Base comprising 6,047 patients with gastric adenocarcinoma treated at 691 hospitals were assessed. The mean number of patients treated was larger at teaching hospitals (14/year) when compared to community centers (5–9/year) (p < 0.05). The utilization of laparoscopy and endoscopic ultrasonography were significantly more common at teaching centers (p < 0.01). Pathologic assessment of greater than 15 nodes was documented in 31% of specimen at community hospitals and 38% at teaching hospitals (p < 0.01). Adjusted for cancer stage, chemotherapy and radiation therapy were utilized with equal frequency at all types of treatment centers. The 30-day postoperative mortality was lowest at teaching hospitals (5.5%) and highest at community hospitals (9.9%) (p < 0.01). These data support previous publications demonstrating that patients with diseases requiring specialized treatment have lower operative mortality when treated at high-volume centers.

Keywords

Gastric cancer Operative mortality Hospital volume Survival NCDB 

Abbreviations

AJCC

American Joint Committee on Cancer

CoC

Commission on Cancer

CHCP

Community Hospital Cancer Program

COMP

Community Hospital Comprehensive Cancer Program

NCDB

National Cancer Data Base

PCE

Patient Care Evaluation

THCP

Teaching Hospital Cancer Program

US

United States

Notes

References

  1. 1.
    American Cancer Society. Cancer Facts and Figures 2006. Atlanta, GA: American Cancer Society, 2006.Google Scholar
  2. 2.
    Hundahl SA, Phillips JL, Menck HR. The National Cancer Data Base report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy: Fifth edition American Joint Committee on Cancer staging, proximal disease, and the “different disease” hypothesis. Cancer 2000;88:921–932.PubMedCrossRefGoogle Scholar
  3. 3.
    Imamura Y, Yoshimi I. Comparison of cancer mortality (stomach cancer) in five countries: France, Italy, Japan, UK and USA from the WHO mortality database (1960–2000). Jpn J Clin Oncol 2005;35:103–105.PubMedCrossRefGoogle Scholar
  4. 4.
    Testa T, Nahum MA, Spinelli E, Carbone E, Flocchini GP, Motta G. The “Will Rogers effect” on stage grading. Ann Ital Chir 1999;70:829–830.PubMedGoogle Scholar
  5. 5.
    Birkmeyer JD, Warshaw Al, Finlayson SRG, Grove MR, Tosteson ANA. Relationship between hospital volume and late survival after pancreaticoduodectomy. Surgery 1999;126:78–83.CrossRefGoogle Scholar
  6. 6.
    Bach PB, Cramer LD, Schrag D, Downey RJ, Gelfand SE, Begg CB. The influence of hospital volume on survival after resection for lung cancer. N Engl J Med 2001;345:81–88.CrossRefGoogle Scholar
  7. 7.
    Schrag D, Cramer LD, Bach PB, Cohen AM, Warren JL, Begg CB. Influence of hospital procedure volume on outcomes following surgery for colon cancer. JAMA 2000;284:3028–3035.PubMedCrossRefGoogle Scholar
  8. 8.
    Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128–1137.PubMedCrossRefGoogle Scholar
  9. 9.
    Nomura E, Tsukuma H, Ajiki W, Oshima A. Population-based study of relationship between hospital surgical volume and 5-year-survival of stomach cancer patients in Osaka, Japan. Cancer Sci 2003;94:998–1002.PubMedCrossRefGoogle Scholar
  10. 10.
    North American Association of Central Cancer Registries. Standards for cancer registries. In Hultstrom D, ed. Required Status Table, vol. II, version 10, Chap. IX. Springfield, IL: NAACCR, 2002, pp 107–118.Google Scholar
  11. 11.
    Commission on Cancer. Standards of the Commission on Cancer, vol. II: Registry Operations and Data Standards. Chicago, IL: American College of Surgeons, 1998.Google Scholar
  12. 12.
    Shaffer JP. Multiple hypothesis testing. Annu Rev Psychol 1995;46:561–584.CrossRefGoogle Scholar
  13. 13.
    The Research Group for Population-based Cancer Registration in Japan. Cancer incidence and incidence rates in Japan in 1999: Estimates based on data from 11 population-based cancer registries. Jpn J Clin Oncol 2004;34:352–356.CrossRefGoogle Scholar
  14. 14.
    Wanebo HJ, Kennedy BJ, Winchester DP, Fremgen A, Stewart AK. Gastric carcinoma: Does lymph node dissection alter survival? J Am Coll Surg 1996;183:616–624.PubMedGoogle Scholar
  15. 15.
    Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, van Elk P, Obertop H, Gouma DJ, Taat CW, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995;345:745–748.PubMedCrossRefGoogle Scholar
  16. 16.
    Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: Preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet 1996;347:995–999.PubMedCrossRefGoogle Scholar
  17. 17.
    Fujii M, Sasaki J, Nakajima T. State of the art in the treatment of gastric cancer: From the 71st Japanese Gastric Cancer Congress. Gastric Cancer 1999;2:151–157.PubMedCrossRefGoogle Scholar
  18. 18.
    Sano T, Katai H, Sasako M, Maruyama K. One thousand consecutive gastrectomies without operative mortality. Br J Surg 2002;89:123.PubMedGoogle Scholar
  19. 19.
    Kodera Y, Sasako M, Yamamoto S, Sano T, Nashimoto A, Kurita A, Gastric Cancer Surgery Study Group of Japan Clinical Oncology Group. Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg 2005;92:1103–1109.PubMedCrossRefGoogle Scholar
  20. 20.
    Wainess RM, Dimick JB, Upchurch GR Jr, Cowan JA, Mulholland MW. Epidemiology of surgically treated gastric cancer in the United States, 1988–2000. J Gastrointest Surg 2003;7:879–883.PubMedCrossRefGoogle Scholar
  21. 21.
    Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128–1137.PubMedCrossRefGoogle Scholar
  22. 22.
    Jarhult J. The importance of volume for outcome in cancer surgery—an overview. Eur J Surg Oncol 1996;22:205–210.PubMedCrossRefGoogle Scholar
  23. 23.
    Bottcher K, Siewert JR, Roder JD, Busch R, Hermanek P, Meyer HJ. Risk of surgical therapy of stomach cancer in Germany. Results of the German 1992 Stomach Cancer Study. German Stomach Cancer Study Group (‘92). Chirurg 1994;65:298–306.PubMedGoogle Scholar
  24. 24.
    Damhuis RA, Meurs CJ, Dijkhuis CM, Stassen LP, Wiggers T. Hospital volume and post-operative mortality after resection for gastric cancer. Eur J Surg Oncol 2002;28:401–405.PubMedCrossRefGoogle Scholar
  25. 25.
    Karpeh MS, Leon L, Klimstra D, Brennan MF. Lymph node staging in gastric cancer: Is location more important than number? An analysis of 1,038 patients. Ann Surg 2000;232:362–371.PubMedCrossRefGoogle Scholar
  26. 26.
    Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol 2005;23:7114–7124.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Kaye M. Reid-Lombardo
    • 1
    Email author
  • Greer Gay
    • 2
  • Lina Patel-Parekh
    • 2
  • Jaffer A. Ajani
    • 3
  • John H. Donohue
    • 1
  • Gastric Patient Care Evaluation Group from the Commission on Cancer
  1. 1.Department of SurgeryMayo ClinicRochesterUSA
  2. 2.American College of Surgeons, Commission on CancerChicagoUSA
  3. 3.Department of Gastrointestinal Medical OncologyThe University of Texas, M.D. Anderson Cancer CenterHoustonUSA

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