UvA-DARE (Digital Academic Repository) Carcinogenesis and treatment of adenocarcinoma of the oesophagus and gastric cardia

Background. Hospital mortality after oesophhagectomy has decreased from 29% to 7.5% over the last decades, due to improved surgical techniques and better peri-operative care. Suggestions have been made that a further decrease in hospital mortality might be achieved by centralisation of oesophagectomies in high volume centres. Patients and Methods. The effect of hospital volume on hospital mortality after oesophagectomy m the Netherlands was analysed based on data from the Dutch National Medical Registry and the Dutch Network and National Database for Pathology over the period 1993-1998. Results. Annually ca. 310 (range 264 321) oesophagectomies are performed in the Netherlands. Fifty-two percent are performed in 43 55 low volume centres (1-10 resections/year). Six percent are performed in 1 3 medium volume centres (11-20 resections/year). The remaining 42% are performed in two high volume centres (>50 resections/year). Hospital mortality is 12.1%, 7.5% and 4.9% respectively (pO.001), while there seem to be slightly more advanced tumours in the high volume centres. Conclusions. There is a significant (inverse) relation between hospital mortality and hospital volume for oesophageal resection in the Netherlands. Although hospital mortality is not the only measure for quality of care, these data suggest a potential beneficial effect of centralisation of oesophagectomy m the Netherlands.