Towards the centralization of digestive oncologic surgery: changes in activity, techniques and outcome

• Published in: Revista española de enfermedades digestivas Vol. 109; no. 9; pp. 634 - 642
• Main Authors: Tebé, Cristian, Pla, Roger, Espinàs, Josep Alfons, Corral, Julieta, Puigdomenech, Elisa, Borràs, Josep Maria, Pons, Joan M V, Espallargues, Mireia
• Format: Journal Article
• Language: English; Spanish
• Published: Spain Sociedad Espanola de Patologia Digestivas 01-09-2017; Sociedad Española de Patología Digestiva; Aran Ediciones
• Subjects: Adult; Aged; Aged, 80 and over; Cancer research; Clinical-administrative databases; Cohort Studies; Digestive oncology surgery; Digestive System Neoplasms - therapy; Digestive System Surgical Procedures - statistics & numerical data; Digestive System Surgical Procedures - trends; Female; Gastroenterology & Hepatology; Geriatrics & Gerontology; Health aspects; Hospital Mortality; Humans; Infectious Diseases; Liver; Male; Medical centers; Methods; Middle Aged; Mortality; Oncology; Oncology Service, Hospital - organization & administration; Outcomes; Pancreatic cancer; Pathology; Pharmacology & Pharmacy; Radiology, Nuclear Medicine & Medical Imaging; Regionalization; Retrospective Studies; Spain; Surgery; Treatment Outcome; Variations; Volume; Bases de datos clínico-administrativas; Resultados; Mortality; Clinical-administrative databases; Variations; Mortalidad; Regionalization; Outcomes; Cirugía oncología digestiva; Volume; Variaciones; Regionalización; Digestive oncology surgery; Volumen
• ISSN: 1130-0108
• DOI: 10.17235/reed.2017.4710/2016

The objective of the present study was to examine changes in the activity, surgical techniques and results from the process of centralization of complex digestive oncologic surgery in 2005-2012 as compared to 1996-2000.
A retrospective cohort study employing the minimum basic data set of hospital discharge (MBDSHD 1996-2012) from public centers in Catalonia (Spain) was performed. The population consisted of individuals aged > 18 who underwent digestive oncologic surgery (esophagus, pancreas, liver, stomach or rectum). Medical centers were divided into low, medium, and high-volume centers (≤ 5, 6-10, and > 10 interventions/year, respectively). The tendency Chi-squared test was used to assess the centralization of patients in high-volume centers and hospital mortality evolution during the study period. Logistic regression was performed to assess the relationship between volume and outcome.
A centralization of complex oncologic digestive surgery between 10% (liver) and 46% (esophagus) was obtained by means of a reduction in the number of hospitals that perform these interventions and a significant rise in the number of patients operated in high-volume centers (all types p ≤ 0.0001, except for esophagus). A significant decrease in mortality was observed, especially in esophagus (from 15% in 1996/2000 to 7% in 2009/12, p = 0.003) and pancreas (from 12% in 1996/2000 to 6% in 2009/12, p trend < 0.0001).
A centralization of oncologic digestive surgery in high-volume centers and a reduction of hospital mortality in Catalonia were reported among esophageal and pancreatic cancers. However, no significant changes were found for others cancer types.