Influence of national centralization of oesophagogastric cancer on management and clinical outcome from emergency upper gastrointestinal conditions. BJS 2018; 105: 113-120.
Published: 20th November 2017
Authors: S. R. Markar, H. Mackenzie, T. Wiggins, A. Askari, A. Karthikesalingam, O. Faiz et al.
In England in 2001 oesophagogastric cancer surgery was centralized. The aim of this study was to evaluate whether centralization of oesophagogastric cancer to high‐volume centres has had an effect on mortality from different emergency upper gastrointestinal conditions.
The Hospital Episode Statistics database was used to identify patients admitted to hospitals in England (1997–2012). The influence of oesophagogastric high‐volume cancer centre status (20 or more resections per year) on 30‐ and 90‐day mortality from oesophageal perforation, paraoesophageal hernia and perforated peptic ulcer was analysed.
Over the study interval, 3707, 12 441 and 56 822 patients with oesophageal perforation, paraoesophageal hernia and perforated peptic ulcer respectively were included. There was a passive centralization to high‐volume cancer centres for oesophageal perforation (26·9 per cent increase), paraoesophageal hernia (19·5 per cent increase) and perforated peptic ulcer (23·0 per cent increase). Management of oesophageal perforation in high‐volume centres was associated with a reduction in 30‐day (HR 0·58, 95 per cent c.i. 0·45 to 0·74) and 90‐day (HR 0·62, 0·49 to 0·77) mortality. High‐volume cancer centre status did not affect mortality from paraoesophageal hernia or perforated peptic ulcer. Annual emergency admission volume thresholds at which mortality improved were observed for oesophageal perforation (5 patients) and paraoesophageal hernia (11). Following centralization, the proportion of patients managed in high‐volume cancer centres that reached this volume threshold was 88·0 per cent for oesophageal perforation, but only 30·3 per cent for paraoesophageal hernia.
Centralization of low incidence conditions such as oesophageal perforation to high‐volume cancer centres provides a greater level of expertise and ultimately reduces mortality.Full text
You may also be interested in
Quality assurance of surgery in the randomized ST03 trial of perioperative chemotherapy in carcinoma of the stomach and gastro‐oesophageal junction.
Authors: W. H. Allum, E. C. Smyth, J. M. Blazeby, H. I. Grabsch, S. M. Griffin, S. Rowley et al.
Meta‐analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis.
Authors: N. Moody, A. Adiamah, F. Yanni, D. Gomez
Authors: Y. Y. Broza, S. Khatib, A. Gharra, A. Krilaviciute, H. Amal, I. Polaka et al.
Authors: S. Ahlin, C. Cefalù, I. Bondia‐Pons, E. Capristo, L. Marini, A. Gastaldelli et al.
Development and validation of a staging system for gastric adenocarcinoma after neoadjuvant chemotherapy and gastrectomy with D2 lymphadenectomy.
Authors: J. X. Lin, C. Yoon, J. Desiderio, B. C. Yi, P. Li, C. H. Zheng et al.
Hepatectomy for hepatocellular carcinoma after perioperative management of portal hypertension. BJS 2019; 106: 1066-1074.
Authors: N. Takemura, T. Aoki, K. Hasegawa, J. Kaneko, J. Arita, N. Akamatsu et al.
Meta‐analysis of risk factors and complications associated with atrial fibrillation after oesophagectomy. BJS 2019; 106: 534-547.
Authors: D. Schizas, M. Kosmopoulos, S. Giannopoulos, S. Giannopoulos, D. G. Kokkinidis, N. Karampetsou et al.
Changes in gut hormones, glycaemic response and symptoms after oesophagectomy. BJS 2019; 106: 735-746.
Authors: J. A. Elliott, N. G. Docherty, C. F. Murphy, H.‐G. Eckhardt, S. L. Doyle, E. M. Guinan et al.
Diagnostic performance of MRI for assessment of response to neoadjuvant chemoradiotherapy in oesophageal cancer. BJS 2019; 106: 596-605.
Authors: S. E. Vollenbrock, F. E. M. Voncken, J. M. van Dieren, D. M. J. Lambregts, M. Maas, G. J. Meijer et al.
Major hepatectomy with or without pancreatoduodenectomy for advanced gallbladder cancer. BJS 2019; 106: 626-635.
Authors: T. Mizuno, T. Ebata, Y. Yokoyama, T. Igami, J. Yamaguchi, S. Onoe et al.
Meta‐analysis of clinical outcome after treatment for achalasia based on manometric subtypes. BJS 2019; 106: 332-341.
Authors: C. Andolfi, P. M. Fisichella