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B P L Wijnhoven - One of the best experts on this subject based on the ideXlab platform.
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a population based study on lymph node retrieval in patients with esophageal Cancer results from the dutch Upper Gastrointestinal Cancer audit
Annals of Surgical Oncology, 2018Co-Authors: L R Van Der Werf, M I Van Berge Henegouwen, J L Dikken, Valery E P P Lemmens, Grard A P Nieuwenhuijzen, B P L WijnhovenAbstract:Background: For esophageal Cancer, the number of retrieved lymph nodes (LNs) is often used as a quality indicator. The aim of this study is to analyze the number of retrieved LNs in The Netherlands, assess factors associated with LN yield, and explore the association with short-term outcomes. This is a population-based study on lymph node retrieval in patients with esophageal Cancer, presenting results from the Dutch Upper Gastrointestinal Cancer Audit. Study Design: For this retrospective national cohort study, patients with esophageal carcinoma who underwent esophagectomy between 2011 and 2016 were included. The primary outcome was the number of retrieved LNs. Univariable and multivariable regression analyses were used to test for association with ≥ 15 LNs. Patients and Results: 3970 patients were included. Between 2011 and 2016, the median number of LNs increased from 15 to 20. Factors independently associated with ≥ 15 LNs were: 0–10 kg preoperative weight loss (versus: unknown weight loss, odds ratio [95% confidence interval]: 0.71 [0.57–0.88]), Charlson score 0 (versus: Charlson score 2: 0.76 [0.63–0.92]), cN2 category (reference: cN0, 1.32 [1.05–1.65]), no neoadjuvant therapy and neoadjuvant chemotherapy (reference: neoadjuvant chemoradiotherapy, 1.73 [1.29–2.32] and 2.15 [1.54–3.01]), minimally invasive transthoracic (reference: open transthoracic, 1.46 [1.15–1.85]), open transthoracic (versus open and minimally invasive transhiatal, 0.29 [0.23–0.36] and 0.43 [0.32–0.59]), hospital volume of 26–50 or > 50 resections/year (reference: 0–25, 1.94 [1.55–2.42] and 3.01 [2.36–3.83]), and year of surgery [reference: 2011, odds ratios (ORs) 1.48, 1.53, 2.28, 2.44, 2.54]. There was no association of ≥ 15 LNs with short-term outcomes. Conclusions: The number of LNs retrieved increased between 2011 and 2016. Weight loss, Charlson score, cN category, neoadjuvant therapy, surgical approach, year of resection, and hospital volume were all associated with increased LN yield. Retrieval of ≥ 15 LNs was not associated with increased postoperative morbidity/mortality.
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a population based study on lymph node retrieval in patients with esophageal Cancer results from the dutch Upper Gastrointestinal Cancer audit
Annals of Surgical Oncology, 2018Co-Authors: L R Van Der Werf, J L Dikken, M I Van Berge Henegouwen, Valery E P P Lemmens, Grard A P Nieuwenhuijzen, B P L WijnhovenAbstract:textabstractBackground: For esophageal Cancer, the number of retrieved lymph nodes (LNs) is often used as a quality indicator. The aim of this study is to analyze the number of retrieved LNs in The Netherlands, assess factors associated with LN yield, and explore the association with short-term outcomes. This is a population-based study on lymph node retrieval in patients with esophageal Cancer, presenting results from the Dutch Upper Gastrointestinal Cancer Audit. Study Design: For this retrospective national cohort study, patients with esophageal carcinoma who underwent esophagectomy between 2011 and 2016 were included. The primary outcome was the number of retrieved LNs. Univariable and multivariable regression analyses were used to test for association with ≥ 15 LNs. Patients and Results: 3970 patients were included. Between 2011 and 2016, the median number of LNs increased from 15 to 20. Factors independently associated with ≥ 15 LNs were: 0–10 kg preoperative weight loss (versus: unknown weight loss, odds ratio [95% confidence interval]: 0.71 [0.57–0.88]), Charlson score 0 (versus: Charlson score 2: 0.76 [0.63–0.92]), cN2 category (reference: cN0, 1.32 [1.05–1.65]), no neoadjuvant therapy and neoadjuvant chemotherapy (reference: neoadjuvant chemoradiotherapy, 1.73 [1.29–2.32] and 2.15 [1.54–3.01]), minimally invasive transthoracic (reference: open transthoracic, 1.46 [1.15–1.85]), open transthoracic (versus open and minimally invasive transhiatal, 0.29 [0.23–0.36] and 0.43 [0.32–0.59]), hospital volume of 26–50 or > 50 resections/year (reference: 0–25, 1.94 [1.55–2.42] and 3.01 [2.36–3.83]), and year of surgery [reference: 2011, odds ratios (ORs) 1.48, 1.53, 2.28, 2.44, 2.54]. There was no association of ≥ 15 LNs with short-term outcomes. Conclusions: The number of LNs retrieved increased between 2011 and 2016. Weight loss, Charlson score, cN category, neoadjuvant therapy, surgical approach, year of resection, and hospital volume were all associated with increased LN yield. Retrieval of ≥ 15 LNs was not associated with increased postoperative morbidity/mortality.
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early outcomes from the dutch Upper Gastrointestinal Cancer audit
British Journal of Surgery, 2016Co-Authors: L A D Busweiler, B P L Wijnhoven, M I Van Berge Henegouwen, D Henneman, N C T Van Grieken, Michel W J M Wouters, R Van Hillegersberg, J W Van SandickAbstract:BACKGROUND: In 2011, the Dutch Upper Gastrointestinal Cancer Audit (DUCA) group began nationwide registration of all patients undergoing surgery with the intention of resection for oesophageal or gastric Cancer. The aim of this study was to describe the initiation and implementation of this process along with an overview of the results. METHODS: The DUCA is part of the Dutch Institute for Clinical Auditing. The audit provides (surgical) teams with reliable, weekly updated, benchmarked information on process and (case mix-adjusted) outcome measures. To accomplish this, a web-based registration was designed, based on a set of predefined quality measures. RESULTS: Between 2011 and 2014, a total of 2786 patients with oesophageal Cancer and 1887 with gastric Cancer were registered. Case ascertainment approached 100 per cent for patients registered in 2013. The percentage of patients with oesophageal Cancer starting treatment within 5 weeks of diagnosis increased significantly over time from 32·5 per cent in 2011 to 41·0 per cent in 2014 (P < 0·001). The percentage of patients with a minimum of 15 examined lymph nodes in the resected specimen also increased significantly for both oesophageal Cancer (from 50·3 per cent in 2011 to 73·0 per cent in 2014; P < 0·001) and gastric Cancer (from 47·5 per cent in 2011 to 73·6 per cent in 2014; P < 0·001). Postoperative mortality remained stable (around 4·0 per cent) for patients with oesophageal Cancer, and decreased for patients with gastric Cancer (from 8·0 per cent in 2011 to 4·0 per cent in 2014; P = 0·031). CONCLUSION: Nationwide implementation of the DUCA has been successful. The results indicate a positive trend for various process and outcome measures.
Philip R. Taylor - One of the best experts on this subject based on the ideXlab platform.
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association between oral leukoplakia and risk of Upper Gastrointestinal Cancer death a follow up study of the linxian general population trial
Thoracic Cancer, 2017Co-Authors: He Liang, Youlin Qiao, Zhao Yang, Jianbing Wang, Jinhu Fan, Philip R. TaylorAbstract:Background This study was conducted to explore the association between oral leukoplakia (OL) and the risk of Upper Gastrointestinal Cancer death in the Linxian General Population Trial Cohort. Methods A prospective cohort study of the Linxian General Population Trial Cohort was performed. Participants with OL were treated as an exposed group, and the remainder was selected as a control group. All subjects were followed monthly by village health workers and reviewed quarterly by the Linxian Cancer Registry. Hazard ratios (HRs) and 95% confidence interval (CIs) were evaluated using proportional hazard and proportional subdistribution hazard models, respectively. Results Over a median of 27 years of observation, 29 476 subjects were followed-up. A total of 17 473 deaths occurred, including 2345 esophageal squamous cell carcinoma (ESCC), 1139 gastric cardia carcinoma, and 506 gastric non-cardia carcinoma deaths. Significant increased ESCC mortality was observed in subjects with OL (exposed 9.66% vs. unexposed 7.39%; P < 0.0001). Furthermore, subjects with OL had a 22% higher risk of death from ESCC (HR 1.22, 95% CI 1.10–1.34; P = 0.0001) after adjusted covariates. In subjects aged ≤52 at the baseline, OL was significantly associated with an elevated risk of ESCC mortality (HR 1.32, 95% CI 1.13–1.54; P = 0.0005). No significant associations were observed for gastric cardia carcinoma and non-cardia carcinoma mortality. Conclusions OL may increase the risk of ESCC mortality, especially in the younger population. These associations should be investigated in further studies.
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jasmine tea consumption and Upper Gastrointestinal Cancer in china
Cancer Causes & Control, 2009Co-Authors: Ying Gao, Xiaoyou Han, Carol Giffen, Ti Ding, Alisa M Goldstein, Philip R. TaylorAbstract:Introduction Epidemiological data on green/jasmine tea and esophageal as well as gastric Cancer are limited and inconclusive.
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Jasmine tea consumption and Upper Gastrointestinal Cancer
2009Co-Authors: Nan Hu, Han Carol, Ding Alisa, M. Goldstein, Philip R. TaylorAbstract:Introduction Epidemiological data on green/jasmine tea and esophageal as well as gastric Cancer are limited and inconclusive. Methods In order to study the effect of jasmine tea in Upper Gastrointestinal (UGI) Cancers, we evaluated 600 esophageal squamous cell carcinoma (ESCC), 598 gastric cardia Cancer (GCA), and 316 gastric non-cardia Cancer (GNCA) cases and 1,514 age-, gender-, and neighborhood matched controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from logistic regression adjusted for matching factors and potential confounders. Results Among controls, 35% of males and 8% of females reported consumption of jasmine tea; other tea consumption was rare. Consumption of jasmine tea (ever vs. never) was not associated with risk of ESCC (OR = 1.15, 95% CI 0.92-1.44), GCA (OR =1.14, 95% CI 0.88-1.37), or GNCA (OR = 0.85, 95% CI 0.64-1.15)
N.a. Stephens - One of the best experts on this subject based on the ideXlab platform.
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evaluating potential biomarkers of cachexia and survival in skeletal muscle of Upper Gastrointestinal Cancer patients
Journal of Cachexia Sarcopenia and Muscle, 2015Co-Authors: N.a. Stephens, R.j.e. Skipworth, Iain J Gallagher, Carolyn A Greig, Denis C Guttridge, James A Ross, Kenneth C H FearonAbstract:Background In order to grow the potential therapeutic armamentarium in the cachexia domain of supportive oncology, there is a pressing need to develop suitable biomarkers and potential drug targets. This pilot study evaluated several potential candidate biomarkers in skeletal muscle biopsies from a cohort of Upper Gastrointestinal Cancer (UGIC) patients. Methods One hundred seven patients (15 weight-stable healthy controls (HC) and 92 UGIC patients) were recruited. Mean (standard deviation) weight-loss of UGIC patients was 8.1 (9.3%). Cachexia was defined as weight-loss ≥5%. Rectus abdominis muscle was obtained at surgery and was analysed by western blotting or quantitative real-time–polymerase chain reaction. Candidate markers were selected according to previous literature and included Akt and phosphorylated Akt (pAkt, n = 52), forkhead box O transcription factors (n = 59), ubiquitin E3 ligases (n = 59, control of muscle anabolism/catabolism), BNIP3 and GABARAPL1 (n = 59, as markers of autophagy), myosin heavy-chain (MyHC, n = 54), dystrophin (n = 39), β-dystroglycan (n = 52), and β-sarcoglycan (n = 52, as markers of structural alteration in a muscle). Patients were followed up for an average of 1255 days (range 581–1955 days) or until death. Patients were grouped accordingly and analysed by (i) all Cancer patients vs. HC; (ii) cachectic vs. non-cachectic Cancer patients; and (iii) Cancer patients surviving ≤1 vs. >1 year post operatively. Results Cancer compared with HC patients had reduced mean (standard deviation) total Akt protein [0.49 (0.31) vs. 0.89 (0.17), P = 0.001], increased ratio of phosphorylated to total Akt [1.33 (1.04) vs. 0.32 (0.21), P = 0.002] and increased expression of GABARAPL1 [1.60 (0.76) vs. 1.10 (0.57), P = 0.024]. β-Dystroglycan levels were higher in cachectic compared with non-cachectic Cancer patients [1.01 (0.16) vs. 0.87 (0.20), P = 0.007]. Survival was shortened in patients with low compared with high MyHC levels (median 316 vs. 1326 days, P = 0.023) and dystrophin levels (median 341 vs. 660 days, P = 0.008). Conclusions The present study has identified intramuscular protein level of β-dystroglycan as a potential biomarker of Cancer cachexia. Changes in the structural elements of muscle (MyHC or dystrophin) appear to be survival biomarkers.
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proteomic analysis of urinary Upper Gastrointestinal Cancer markers
Proteomics Clinical Applications, 2011Co-Authors: Holger Husi, N.a. Stephens, Iain J Gallagher, Carolyn A Greig, Kenneth C H Fearon, Andrew D Cronshaw, A J Macdonald, James A RossAbstract:Purpose: We have investigated the use of human urine as a non-invasive medium to screen for molecular biomarkers of carcinomas of the Upper Gastrointestinal (uGI) tract using SELDI-TOF-MS. Experimental design: A total of 120 urine specimens from 60 control and 60 uGI Cancer patients were analysed to establish a potential biomarker fingerprint for the weak cation exchanger CM10 chip surface, which was validated by blind testing using a further 59 samples from 33 control and 26 uGI Cancer patients. Results: Using Biomarker Pattern software, we established a model with a sensitivity of 98% and specificity of 95% for the learning sample set, and a sensitivity of 96% and specificity of 72% for the validation data set. Model variable importance included six peptides with m/z of 10 230, 10 436, 10 574, 10 311, 10 467, and 1 0118 of which the 10 230 molecular species was the main decider (sensitivity 86% and specificity 80%). Initial protein database searching identified 10 230 as S100-A6, 10 436 as S100-P, 10 467 as S100-A9, and 10 574 as S100-A12 of which S100-A6 and S100-A9 were confirmed by Western blotting. Conclusions and clinical relevance: We have demonstrated that SELDI-TOF-MS as a screening tool is a rapid and valid methodology in the search for urinary Cancer biomarkers, and is potentially useful in defining and consolidating biomarker patterns for uGI Cancer screening.
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The relationship between hospital volume and post-operative mortality rates for Upper Gastrointestinal Cancer resections: Scotland 1982-2003
EJSO - European Journal of Surgical Oncology, 2010Co-Authors: R.j.e. Skipworth, R.w. Parks, N.a. Stephens, C. Graham, D.h. Brewster, O.j. Garden, S. Paterson-brownAbstract:Centralisation of surgical treatment of Cancer has resulted in improved outcomes. We aimed to determine evidence of benefit for specialised management of Upper Gastrointestinal Cancer in high-volume centres in Scotland.
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The relationship between hospital volume and post-operative mortality rates for Upper Gastrointestinal Cancer resections: Scotland 1982-2003.
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2009Co-Authors: R.j.e. Skipworth, R.w. Parks, N.a. Stephens, C. Graham, D.h. Brewster, O.j. Garden, S. Paterson-brownAbstract:Abstract Background Centralisation of surgical treatment of Cancer has resulted in improved outcomes. We aimed to determine evidence of benefit for specialised management of Upper Gastrointestinal Cancer in high-volume centres in Scotland. Methods Discharge records of patients undergoing oesophagectomy, gastrectomy, hepatectomy or pancreatectomy between 1982 and 2003 were identified. Hospital data were analysed on a year-by-year basis to derive ‘hospital-years'. Hospital-years were divided into quartiles by volume, and were analysed with regard to in-hospital mortality during the operative admission [Chi-square test ( χ 2 ) and Chi-square test for trend ( χ 2 trend )]. Results 10,625 patients and 982 in-hospital deaths were included. In-hospital mortality rates declined during the study period: oesophagectomy 11.7–7.9%; gastrectomy 11.2–7.2%; hepatectomy 11.1–3.0%; and pancreatectomy 8.3–4.9%. For all resections except gastrectomy, mortality decreased as quartile of hospital-year volume increased (oesophagectomy: χ 2 p =0.006, χ 2 trend p =0.001; hepatectomy: χ 2 p =0.004, χ 2 trend p =0.003; pancreatectomy: χ 2 p =0.002, χ 2 trend p =0.001). ORs of death were lower for oesophagectomy (OR=0.58; 95%CI=0.39, 0.88; p =0.009) and pancreatectomy (OR=0.35; 95%CI=0.19, 0.64; p Conclusion Concentration of Cancer care has had major effects on health service delivery in Scotland. Centralisation should be supported in surgical management of Upper Gastrointestinal Cancer.
Nigel Trudgill - One of the best experts on this subject based on the ideXlab platform.
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PTH-016 Factors Associated with Upper Gastrointestinal Cancer Occurrence After OGD that Did Not Detect Cancer in The West Midlands
Gut, 2016Co-Authors: Danny Cheung, J Rees, T Evans, Nigel TrudgillAbstract:Introduction Up to 14% of Upper Gastrointestinal Cancer (UGIC) subjects had an OGD that did not diagnose Cancer up to 3 years prior to diagnosis. The rate of and associated risk factors for post-OGD Upper Gastrointestinal Cancer (POUGIC) in the West Midlands were examined. Methods Computerised OGD records from 8 NHS trusts in the West Midlands between 1998 and 2010 were retrieved and submitted to the West Midlands Cancer Intelligence Unit (WMCIU) for UGIC registrations linkage. Subjects undergoing OGD 3 to 36 months before diagnosis were identified as POUGIC and subjects with no OGD 3 to 36 months prior to diagnosis served as controls. The influence of age, gender, indication, endoscopist specialty, trainee involvement, sedation, number of biopsies taken from focal abnormalities, site and histology of UGIC on POUGIC were examined by logistic regression analysis. Results 115,113 OGD records were submitted to WMCIU and 3870 UGIC were linked. After exclusions, 2909 UGIC subjects were analysed. There were 275 (9.5%) POUGIC subjects (154 oesophageal Cancer (OC) and 121 gastric Cancer (GC)). The POUGIC rate ranged from 7.6 to 11.8% between the trusts. Of the POUGIC subjects, 143 (52.0%) had OGD 3 to 12 months and 132 (48.0%) 12 to 36 months prior to UGIC diagnosis. POUGIC subjects were younger (69.6±11.7 yrs) compared with controls (72.0±11.6 yrs) (p = 0.001). There were no association between POUGIC and OC or GC (GC OR 1.15, 95%CI 0.89–1.48, p = 0.289) or subject gender (female 1.14, 0.88–1.48, p = 0.312). Subjects with alarm symptoms (0.33, 0.26–0.43, p Conclusion The POUGIC rate in the West Midlands was 9.5% between 1998 and 2010 and varied between 7.6 and 11.8% between trusts. POUGIC was associated with younger age, a lack of alarm symptoms and less biopsies from abnormalities. There was no significant survival difference between POUGIC subjects and controls at 1 yr. Disclosure of Interest None Declared
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Factors Associated with Upper Gastrointestinal Cancer Occurrence After Endoscopy that Did Not Diagnose Cancer.
Digestive diseases and sciences, 2016Co-Authors: Danny Cheung, Shyam Menon, Jonathan Hoare, Anjan Dhar, Nigel TrudgillAbstract:Background and Aims Up to 14 % of Upper Gastrointestinal Cancer (UGIC) subjects underwent esophago-gastro-duodenoscopy (EGD) in the preceding 3 years, which did not detect UGIC. The frequency of such events and associated risk factors was evaluated.
R.j.e. Skipworth - One of the best experts on this subject based on the ideXlab platform.
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identification of diagnostic Upper Gastrointestinal Cancer tissue type specific urinary biomarkers
Biomedical Reports, 2019Co-Authors: Holger Husi, R.j.e. Skipworth, Kenneth C H Fearon, Andrew D Cronshaw, Marco Fernandes, Janice G Miller, James A RossAbstract:Several potential urinary biomarkers exhibiting an association with Upper Gastrointestinal tumour growth have been previously identified, of which S100A6, S100A9, rabenosyn-5 and programmed cell death 6-interacting protein (PDCD6IP) were further validated and found to be upregulated in malignant tumours. The Cancer cohort from our previous study was subclassified to assess whether distinct molecular markers can be identified for each individual Cancer type using a similar approach. Urine samples from patients with Cancers of the stomach, oesophagus, oesophagogastric junction or pancreas were analysed by surface-enhanced laser desorption/ionization-time-of-flight mass spectrometry using both CM10 and IMAC30 (Cu2+-complexed) chip types and LC-MS/MS-based mass spectrometry after chromatographic enrichment. This was followed by protein identification, pattern matching and validation by western blotting. We found 8 m/z peaks with statistical significance for the four Cancer types investigated, of which m/z 2447 and 2577 were identified by pattern matching as fragments of cathepsin-B (CTSB) and cystatin-B (CSTB); both molecules are indicative of pancreatic Cancer. Additionally, we observed a potential association of upregulated α-1-antichymotrypsin with pancreatic and gastric Cancers, of PDCD6IP, vitelline membrane outer layer protein 1 homolog (VMO1) and triosephosphate isomerase (TPI1) with oesophagogastric junctional Cancers, and of complement C4-A, prostatic acid phosphatase, azurocidin and histone-H1 with oesophageal Cancer. Furthermore, the potential pancreatic Cancer biomarkers CSTB and CTSB were validated independently by western blotting. Therefore, the present study identified two new potential urinary biomarkers that appear to be associated with pancreatic Cancer. This may provide a simple, non-invasive screening test for use in the clinical setting.
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evaluating potential biomarkers of cachexia and survival in skeletal muscle of Upper Gastrointestinal Cancer patients
Journal of Cachexia Sarcopenia and Muscle, 2015Co-Authors: N.a. Stephens, R.j.e. Skipworth, Iain J Gallagher, Carolyn A Greig, Denis C Guttridge, James A Ross, Kenneth C H FearonAbstract:Background In order to grow the potential therapeutic armamentarium in the cachexia domain of supportive oncology, there is a pressing need to develop suitable biomarkers and potential drug targets. This pilot study evaluated several potential candidate biomarkers in skeletal muscle biopsies from a cohort of Upper Gastrointestinal Cancer (UGIC) patients. Methods One hundred seven patients (15 weight-stable healthy controls (HC) and 92 UGIC patients) were recruited. Mean (standard deviation) weight-loss of UGIC patients was 8.1 (9.3%). Cachexia was defined as weight-loss ≥5%. Rectus abdominis muscle was obtained at surgery and was analysed by western blotting or quantitative real-time–polymerase chain reaction. Candidate markers were selected according to previous literature and included Akt and phosphorylated Akt (pAkt, n = 52), forkhead box O transcription factors (n = 59), ubiquitin E3 ligases (n = 59, control of muscle anabolism/catabolism), BNIP3 and GABARAPL1 (n = 59, as markers of autophagy), myosin heavy-chain (MyHC, n = 54), dystrophin (n = 39), β-dystroglycan (n = 52), and β-sarcoglycan (n = 52, as markers of structural alteration in a muscle). Patients were followed up for an average of 1255 days (range 581–1955 days) or until death. Patients were grouped accordingly and analysed by (i) all Cancer patients vs. HC; (ii) cachectic vs. non-cachectic Cancer patients; and (iii) Cancer patients surviving ≤1 vs. >1 year post operatively. Results Cancer compared with HC patients had reduced mean (standard deviation) total Akt protein [0.49 (0.31) vs. 0.89 (0.17), P = 0.001], increased ratio of phosphorylated to total Akt [1.33 (1.04) vs. 0.32 (0.21), P = 0.002] and increased expression of GABARAPL1 [1.60 (0.76) vs. 1.10 (0.57), P = 0.024]. β-Dystroglycan levels were higher in cachectic compared with non-cachectic Cancer patients [1.01 (0.16) vs. 0.87 (0.20), P = 0.007]. Survival was shortened in patients with low compared with high MyHC levels (median 316 vs. 1326 days, P = 0.023) and dystrophin levels (median 341 vs. 660 days, P = 0.008). Conclusions The present study has identified intramuscular protein level of β-dystroglycan as a potential biomarker of Cancer cachexia. Changes in the structural elements of muscle (MyHC or dystrophin) appear to be survival biomarkers.
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The relationship between hospital volume and post-operative mortality rates for Upper Gastrointestinal Cancer resections: Scotland 1982-2003
EJSO - European Journal of Surgical Oncology, 2010Co-Authors: R.j.e. Skipworth, R.w. Parks, N.a. Stephens, C. Graham, D.h. Brewster, O.j. Garden, S. Paterson-brownAbstract:Centralisation of surgical treatment of Cancer has resulted in improved outcomes. We aimed to determine evidence of benefit for specialised management of Upper Gastrointestinal Cancer in high-volume centres in Scotland.
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The relationship between hospital volume and post-operative mortality rates for Upper Gastrointestinal Cancer resections: Scotland 1982-2003.
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2009Co-Authors: R.j.e. Skipworth, R.w. Parks, N.a. Stephens, C. Graham, D.h. Brewster, O.j. Garden, S. Paterson-brownAbstract:Abstract Background Centralisation of surgical treatment of Cancer has resulted in improved outcomes. We aimed to determine evidence of benefit for specialised management of Upper Gastrointestinal Cancer in high-volume centres in Scotland. Methods Discharge records of patients undergoing oesophagectomy, gastrectomy, hepatectomy or pancreatectomy between 1982 and 2003 were identified. Hospital data were analysed on a year-by-year basis to derive ‘hospital-years'. Hospital-years were divided into quartiles by volume, and were analysed with regard to in-hospital mortality during the operative admission [Chi-square test ( χ 2 ) and Chi-square test for trend ( χ 2 trend )]. Results 10,625 patients and 982 in-hospital deaths were included. In-hospital mortality rates declined during the study period: oesophagectomy 11.7–7.9%; gastrectomy 11.2–7.2%; hepatectomy 11.1–3.0%; and pancreatectomy 8.3–4.9%. For all resections except gastrectomy, mortality decreased as quartile of hospital-year volume increased (oesophagectomy: χ 2 p =0.006, χ 2 trend p =0.001; hepatectomy: χ 2 p =0.004, χ 2 trend p =0.003; pancreatectomy: χ 2 p =0.002, χ 2 trend p =0.001). ORs of death were lower for oesophagectomy (OR=0.58; 95%CI=0.39, 0.88; p =0.009) and pancreatectomy (OR=0.35; 95%CI=0.19, 0.64; p Conclusion Concentration of Cancer care has had major effects on health service delivery in Scotland. Centralisation should be supported in surgical management of Upper Gastrointestinal Cancer.
