Annals of Surgical Oncology

, Volume 24, Issue 4, pp 1010–1017 | Cite as

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

  • Han Hong Lee
  • Sang-Yong Son
  • Ju Hee Lee
  • Min Gyu Kim
  • Hoon Hur
  • Do Joong Park
Gastrointestinal Oncology

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.

References

  1. 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.CrossRefPubMedGoogle Scholar
  2. 2.
    Maduekwe UN, Yoon SS. An evidence-based review of the surgical treatment of gastric adenocarcinoma. J Gastrointest Surg. 2011;15:730–41.CrossRefPubMedGoogle Scholar
  3. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. 5.
    Jung do H, Son SY, Park YS, et al. The learning curve associated with laparoscopic total gastrectomy. Gastric Cancer. 2016;19:264–72.Google Scholar
  6. 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.CrossRefPubMedGoogle Scholar
  7. 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.CrossRefPubMedGoogle Scholar
  8. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.PubMedGoogle Scholar
  14. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 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.CrossRefPubMedGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.CrossRefPubMedGoogle Scholar
  18. 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.CrossRefPubMedGoogle Scholar
  19. 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.CrossRefPubMedGoogle Scholar
  20. 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.CrossRefPubMedGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. 25.
    Fujisaki M, Shinohara T, Hanyu N, et al. Laparoscopic gastrectomy for gastric cancer in the elderly patients. Surg Endosc. 2016;30:1380–7.CrossRefPubMedGoogle Scholar
  26. 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.CrossRefPubMedGoogle Scholar
  27. 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.CrossRefPubMedGoogle Scholar
  28. 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.CrossRefPubMedGoogle Scholar
  29. 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.CrossRefPubMedGoogle Scholar
  30. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Han Hong Lee
    • 1
  • Sang-Yong Son
    • 2
  • Ju Hee Lee
    • 3
  • Min Gyu Kim
    • 4
  • Hoon Hur
    • 2
  • Do Joong Park
    • 5
  1. 1.Department of Surgery, Uijeongbu St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulKorea
  2. 2.Department of SurgeryAjou University School of MedicineSuwonKorea
  3. 3.Department of SurgeryHanyang University Hospital, Hanyang University School of MedicineSeoulKorea
  4. 4.Department of SurgeryHanyang University Guri Hospital, Hanyang University School of MedicineSeoulKorea
  5. 5.Department of SurgerySeoul National University Bundang Hospital, Seoul National University College of MedicineSeoulKorea

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