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Review
. 2023 Apr 21:10:1161938.
doi: 10.3389/fsurg.2023.1161938. eCollection 2023.

Association of hospital volume and long-term survival after esophagectomy: A systematic review and meta-analysis

Qing Wang  1   2 , Shinji Mine  1 , Motomi Nasu  1 , Tetsu Fukunaga  1 , Shuko Nojiri  3 , Chun-Dong Zhang  4
Affiliations
Review

Association of hospital volume and long-term survival after esophagectomy: A systematic review and meta-analysis

Qing Wang et al. Front Surg. .

Abstract

Background: It remains controversial whether esophageal cancer patients may benefit from esophagectomy in specialized high-volume hospitals. Here, the effect of hospital volume on overall survival (OS) of esophageal cancer patients post esophagectomy was assessed.

Methods: PubMed, Embase, and Cochrane Library were systematically searched for relevant published articles between January 1990 and May 2022. The primary outcome was OS after esophagectomy in high- vs. low-volume hospitals. Random effect models were applied for all meta-analyses. Subgroup analysis were performed based on volume grouping, sample size, study country, year of publication, follow-up or study quality. Sensitivity analyses were conducted using the leave-one-out method. The Newcastle-Ottawa Scale was used to assess the study quality. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidance, and was registered (identifier: INPLASY202270023).

Results: A total of twenty-four studies with 113,014 patients were finally included in the meta-analysis. A significant improvement in OS after esophagectomy was observed in high-volume hospitals as compared to that in their low-volume counterparts (HR: 0.77; 95% CI: 0.71-0.84, P < 0.01). Next, we conducted subgroup analysis based on volume grouping category, consistent results were found that high-volume hospitals significantly improved OS after esophagectomy than their low-volume counterparts. Subgroup analysis and sensitivity analyses further confirmed that all the results were robust.

Conclusions: Esophageal cancer should be centralized in high-volume hospitals.

Keywords: centralization; esophageal carcinoma; esophagectomy; hospital volume; overall survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The PRIMSA flow diagram for included studies.
Figure 2
Figure 2
Forest plot of long-term survivals following esophagectomy comparing high- with low-volume hospitals (reference) according to volume grouping.
Figure 3
Figure 3
Funnel plot of survival benefit following esophagectomy comparing high- with low-volume hospital (reference).
See this image and copyright information in PMC

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