Claassen YHM, et al. - Data from the CRITICS (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach) trial was analyzed to evaluate the effect of hospital volume on quality of gastric cancer surgery. Outcomes suggested better surgical quality in association with surgery performed in high-volume hospitals than surgery carried out in lower-volume hospitals.

Methods

• From the CRITICS trial database, researchers selected patients who underwent gastrectomy with curative intent in the Netherlands.
• They derived annual hospital volume of participating centres from the Netherlands Cancer Registry.
• They categorized hospital volume into very low (1–10 gastrectomies per year per institution), low (11–20), medium (21–30) and high (31 or more), and linked to the CRITICS database.
• Analysis of quality of surgery was performed by surgicopathological compliance (removal of at least 15 lymph nodes), surgical compliance (removal of indicated lymph node stations) and the Maruyama Index.
• Between hospital categories, postoperative morbidity and mortality were also compared.

Results

• Researchers included 788 patients in the CRITICS study, of whom 494 were analysed between 2007 and 2015.
• In high-volume hospitals, surgicopathological compliance was higher (86·7% vs  50·4 % P < 0·001), surgical compliance was greater (52·9% vs 19·8%; P < 0·001) and median Maruyama Index was lower (0 vs 6; P=0·006) compared with very low-volume hospitals.
• No statistically significant difference was noted in postoperative complications or mortality between the hospital volume categories.