Centralization of oesophageal resections for cancer does it improve treatment outcome

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Centralization of oesophageal resections for
cancerdoes it improve treatment outcome?

• Henrike E. Karim-Kos, Michel W.J.M. Wouters,
• Laurents P.S. Stassen, Willem-Hans Steup,
• Rob A.E.M. Tollenaar

Comprehensive Cancer Centre West, Leiden
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Background

• Patients with cancer of the oesophagus or
  gastric cardia
• Complex and high-risk surgery
• Volume-outcome relationship

From 2000 start of centralization
Comprehensive Cancer Centre West, Leiden
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Aim

• To evaluate the effects of
• centralization of
• oesophageal resection for cancer

Comprehensive Cancer Centre West, Leiden
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Methods

• Selection
• - 555 cancer patients who underwent
• oesophageal resection
• - period 1990-2004
• Analysis
• - comparison 3 periods 1990-1994
• 1995-1999
• 2000-2004
• - 2000-2004 comparison hospitals low volume
  (lt10)
• high
  volume ( 10)

Comprehensive Cancer Centre West, Leiden
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Patient characteristics
Comprehensive Cancer Centre West, Leiden
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Treatment outcome
Comprehensive Cancer Centre West, Leiden
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2-year survival (1)
54 (2000-2004)
43 (1995-1999)
38 (1990-1994)
Due to decrease of in-hospital mortality?
Log-rank P0.001
Comprehensive Cancer Centre West, Leiden
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2-year survival (2)
56 (2000-2004)
49 (1995-1999)
44 (1990-1994)
Due to centralization?
Log-rank P0.03
Comprehensive Cancer Centre West, Leiden
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Patient characteristics (2000-2004)
Comprehensive Cancer Centre West, Leiden
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Treatment outcome (2000-2004)
Comprehensive Cancer Centre West, Leiden
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2-year survival (2000-2004)
54 (high volume)
53 (low volume)
Log-rank P0.63
Comprehensive Cancer Centre West, Leiden
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Conclusion

• Treatment outcome improved dramatically in
  2000-2004
• High volume hospitals in 2000-2004
• Less complications
• Shorter hospital stay
• Lower in-hospital mortality
• Survival might improve with continuation of the
  centralization process

Comprehensive Cancer Centre West, Leiden