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Upper Gastrointestinal (lips to ileocecal valve, including esophagus and stomach)

E472: Defining the relationship between hospital surgical volume and hospital delivery of multimodal treatment for gastroesophageal adenocarcinoma: a retrospective cohort study.

Introduction: Receipt of care at high surgical volume centers has been shown to improve short-term outcomes for gastric and esophageal cancer patients. However, multimodal (MM) treatment is the standard of care for most localized gastroesophageal cancers. Therefore, we assessed the assumption that treatment at a high-volume surgical center will lead to higher delivery of MM treatment for resectable gastroesophageal adenocarcinoma patients.

Methods: The National Cancer Database was used to identify a cohort of clinically resectable stage 1-3 gastric and esophageal cancer patients who were eligible for MM treatment. MM treatment was defined as receipt of surgery and chemotherapy and/or radiation. Hospital MM treatment was defined as the number of patients receiving MM treatment by the number of eligible patients per hospital. Descriptive statistics and survival analyses were conducted.

Results: A total 97,808 patients with gastric, gastroesophageal, and esophageal adenocarcinoma met inclusion criteria, of whom 68% received curative-intent surgery and 63% received MM treatment. There was correlation between hospital surgical volume and delivery of MM treatment (Spearman correlation 0.461; P < 0.001). Of the hospitals that delivered MM treatment to >50% of patients, 48% of patients received treatment at the highest surgical volume hospitals (76-100th percentile), 38% at high surgical volume hospitals (51-75th percentile), and 14% at low volume hospitals (26th-50th percentile).   Hospital MM treatment delivery was associated with significantly improved median overall survival (p< 0.001), with low (0-25%), medium ( >25%-50%), and high ( >50%) MM treatment hospitals demonstrating 18, 22, and 34 months, respectively.

Conclusions: There is a moderate associate between hospital surgical volume and hospital delivery of MM treatment for resectable gastroesophageal cancers. Although the impact of surgery at high volume hospitals is well documented, the growing importance of hospital MM treatment delivery and cancer care coordination has been less commonly investigated. Future assessment of the barriers and facilitators of hospital MM care delivery and the role of cancer care coordination is needed.

Learning Objectives:

  • better understand the importance of adherence to guidelines as a metric for quality.
  • more clearly realize the limitations of using volume as a metric for qulity.
  • better understand the importance of adherence to guideline driven treatment.