• Yvette H M Claassen, Romy M van Amelsfoort, Henk H Hartgrink, Johan L Dikken, Wobbe O de Steur, Johanna W van Sandick, van Grieken Nicole C T NCT Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands., Annemieke Cats, Henk Boot, Anouk K Trip, Edwin P M Jansen, Kranenbarg Elma Meershoek-Klein EM Department of Surgical Oncology, Leiden University Medical Center, The Netherlands., Jeffrey P B M Braak, Hein Putter, Mark I van Berge Henegouwen, Marcel Verheij, and van de Velde Cornelis J H CJH Department of Surgical Oncology, Leiden University Medical Center, The Netherlands..
• Department of Surgical Oncology, Leiden University Medical Center, The Netherlands.
• Ann. Surg. 2019 Dec 1; 270 (6): 1096-1102.

ObjectiveWe examined the association between surgical hospital volume and both overall survival (OS) and disease-free survival (DFS) using data obtained from the international CRITICS (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach) trial.Summary Background DataIn the CRITICS trial, patients with resectable gastric cancer were randomized to receive preoperative chemotherapy followed by adequate gastrectomy and either chemotherapy or chemoradiotherapy.MethodsPatients in the CRITICS trial who underwent a gastrectomy with curative intent in a Dutch hospital were included in the analysis. The annual number of gastric cancer surgeries performed at the participating hospitals was obtained from the Netherlands Cancer Registry; the hospitals were then classified as low-volume (1-20 surgeries/year) or high-volume (≥21 surgeries/year) and matched with the CRITICS trial data. Univariate and multivariate analyses were then performed to evaluate the hazard ratio (HR) between hospital volume and both OS and DFS.ResultsFrom 2007 through 2015, 788 patients were included in the CRITICS trial. Among these 788 patients, 494 were eligible for our study; the median follow-up was 5.0 years. Five-year OS was 59.2% and 46.1% in the high-volume and low-volume hospitals, respectively. Multivariate analysis revealed that undergoing surgery in a high-volume hospital was associated with higher OS [HR = 0.69, 95% confidence interval (CI) = 0.50-0.94, P = 0.020] and DFS (HR = 0.73, 95% CI: 0.54-0.99, P = 0.040).ConclusionsIn the CRITICS trial, hospitals with a high annual volume of gastric cancer surgery were associated with higher overall and DFS. These findings emphasize the value of centralizing gastric cancer surgeries in the Western world.

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