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Published on: August 9, 2016
Enforcing centralization for gastric cancer in Denmark.
L S Jensen1, H Nielsen, P B Mortensen
1Department of Surgery, Aarhus University Hospital, Nørrebrogade 44, Aarhus C, Denmark. lonsusje@rm.dk
Summary
Centralizing gastric cancer surgery and implementing national guidelines in Denmark significantly improved surgical quality and reduced 30-day hospital mortality. More patients had adequate lymph node removal post-centralization.
Area of Science:
- Oncology
- Surgical Outcomes
- Public Health Policy
Background:
- Limited population-based data exist on early outcomes after gastric cancer surgery.
- Centralization of gastric cancer surgery and national guidelines were implemented in Denmark.
Purpose of the Study:
- To examine changes in surgical quality and early postoperative outcomes.
- To assess the impact of centralization and national guidelines on gastric cancer surgery.
Main Methods:
- A national database registered patients undergoing gastric cancer resection (July 2003-December 2008).
- Surgical quality and mortality data were compared to the pre-centralization period (1999-2003).
Main Results:
- Anastomotic leakage risk was 5.0% post-centralization vs. 6.1% before.
- 30-day hospital mortality decreased to 2.4% vs. 8.2% before centralization.
- Adequate lymph node removal increased from 19% to 76% during the study period.
Conclusions:
- Centralization and national guidelines improved surgical quality for gastric cancer.
- These changes were associated with substantially lower in-hospital mortality rates.