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Background: It is unclear whether annual hospital volume of bariatric surgery influences the long-term survival of individuals who undergo surgery for severe obesity. The hypothesis that higher annual hospital volume of bariatric surgery is associated with better long-term survival was evaluated. Methods: This retrospective population-based study included patients who underwent bariatric surgery in Sweden and Finland between 1989 and 2020. Annual hospital volume was analysed for risk of all-cause mortality. Multivariable Cox regression provided HRs with 95 per cent confidence intervals adjusted for age, sex, co-morbidity, country, and type of bariatric procedure. Results: Weight loss surgery was performed in 77 870 patients with a 0.5 per cent risk of postoperative death (mortality rate (MR) per 100 000 people 592.7, 95 per cent c.i. 575.0 to 610.9). Higher annual hospital volume of bariatric surgery was associated with a lower risk of all-cause mortality. The adjusted HRs were slightly more reduced for each quartile of annual hospital volume compared with the lowest quartile (MR per 100 000 people for lowest quartile 815.1, 95 per cent c.i. 781.7 to 849.9; for quartile II: HR 0.88, 95 per cent c.i. 0.81 to 0.96 (MR per 100 000 people 545.0, 512.0 to 580.1); for quartile III: HR 0.87, 0.78 to 0.97 (MR per 100 000 people 428.8, 395.5 to 465.0); for quartile IV: HR 0.82, 0.73 to 0.93 (MR per 100 000 people 356.0, 324.1 to 391.1)). In analyses restricted to laparoscopic surgery, volume and mortality were related only in the crude model (HR 0.86, 0.75 to 0.98), but not in the multivariable model (HR 0.97, 0.84 to 1.13) that compared highest and lowest quartiles. Conclusion: If there was a survival benefit associated with hospital volume, it may have been due to a faster uptake of laparoscopic surgery in the busier hospitals. [ABSTRACT FROM AUTHOR]

Cancer surgery conducted late during the working week might decrease long-term survival for some tumours. Studies on how weekday of gastrectomy influences long-term survival following gastric cancer are few and show conflicting results, which prompted the present investigation. This population-based cohort study included almost all patients who underwent gastrectomy for gastric adenocarcinoma in Sweden between 2006 and 2015, with follow-up throughout 2020. Associations between weekday of gastrectomy and 5-year all-cause mortality (main outcome) and 5-year disease-specific mortality (secondary outcome) were analysed using multivariable Cox regression. The hazard ratios (HR) with 95% confidence intervals (CI) were adjusted for age, sex, education, comorbidity, pathological tumour stage, tumour sub-location, neoadjuvant therapy, annual surgeon volume of gastrectomy, and calendar year. Among 1678 patients, surgery on Thursday-Friday was not associated with any statistically significantly increased risk of 5-year all-cause mortality (HR 1.05, 95% CI 0.91–1.22) or 5-year disease-specific mortality (HR 1.04, 95% CI 0.89–1.23) compared to Monday-Wednesday. No associations were found when each weekday was analysed separately, with point estimates close to 1.00 (range 0.98–1.00) Monday-Thursday, but increased for Friday (HR 1.22, 95% CI 0.89–1.68) when fewer patients underwent surgery (4% of all). Stratified analyses by age, comorbidity, tumour stage, neoadjuvant therapy, surgeon volume, and tumour sub-location did not reveal any associations between weekday of surgery on Thursday-Friday compared with Monday-Wednesday and risk of 5-year all-cause mortality. Weekday of gastrectomy might not influence the 5-year survival in patients with gastric adenocarcinoma. [ABSTRACT FROM AUTHOR]

It is uncertain whether centralization of gastrectomy to fewer surgeons and larger centers improves survival in gastric adenocarcinoma in Western populations. The aim of this study was to examine if higher annual surgeon or hospital volumes of gastrectomy increase gastric adenocarcinoma survival in a population-based Swedish cohort. This study included almost all patients who underwent curatively intended gastrectomy for gastric adenocarcinoma in Sweden between 2006 and 2015 with follow-up throughout 2020. Data were collected from medical records and national registries. Annual surgeon and hospital volumes of gastrectomies were analyzed by categorization into four equal-sized groups and as continuous variables. The outcomes were 5-year all-cause mortality (main) and 5-year disease-specific mortality. Cox regression produced hazard ratios (HR) with 95% confidence intervals (95% CI), adjusted for sex, age, education, comorbidity, pathological tumor stage, pre-operative therapy, calendar period, and mutually for hospital or surgeon volume. The study included 1774 patients. Higher annual surgeon volume did not decrease the risk of 5-year all-cause mortality when comparing the highest and lowest quartiles (HR = 1.07, 95% CI 0.86–1.34) or when analyzed as a continuous variable (HR = 1.03, 95% 1.00–1.06). Higher annual hospital volume did not significantly decrease the risk of 5-year all-cause mortality (highest versus lowest quartiles: HR = 0.89, 95% CI 0.71–1.10; continuous variable: HR = 0.98, 95% CI 0.95–1.02). The results for 5-year disease-specific mortality were similar. This study, mirroring routine clinical practices in an entire Western country, indicates that neither annual surgeon volume nor annual hospital volume of gastrectomy influences the long-term survival in gastric adenocarcinoma. [ABSTRACT FROM AUTHOR]

Quality of surgery is essential for survival in gastric adenocarcinoma, but studies examining surgeons' proficiency gain of gastrectomies are scarce. This study aimed to reveal potential proficiency gain curves for surgeons operating patients with gastric cancer. Population-based cohort study of patients who underwent gastrectomy for gastric adenocarcinoma in Sweden between 2006 and 2015 with follow-up throughout 2020. Data were retrieved from national registries and medical records. Risk prediction models were used to calculate outcome probabilities, and risk-adjusted cumulative sum curves were plotted to assess differences (change points) between observed and expected outcomes. The main outcome was long-term (>3–5 years) all-cause mortality after surgery. Secondary outcomes were all-cause mortality within 30 days, 31–90 days, 91 days to 1 year and>1–3 years of surgery, resection margin status, and lymph node yield. The study included 261 surgeons and 1636 patients. The>3- to 5-year mortality was improved after 20 cases, and decreased from 12.4% before to 8.6% after this change point (p = 0.027). Change points were suggested, but not statistically significant, after 22 cases for 30-day mortality, 28 cases for 31- to 90-day mortality, 9 cases for 91-day to 1-year mortality, and 10 cases for>1- to 3-year all-cause mortality. There were statistically significant improvements in tumour-free resection margins after 28 cases (p < 0.005) and greater lymph node yield after 13 cases (p < 0.001). This study reveals proficiency gain curves regarding long-term survival, resection margin status, and lymph node yield in gastrectomy for gastric adenocarcinoma, and that at least 20 gastrectomies should be conducted with experienced support before doing these operations independently. • Is there a learning curve associated with gastrectomy for gastric adenocarcinoma? • This was a nationwide Swedish population-based cohort study. • There was a learning curve with improved long-term survival after 20 gastrectomies. • Surgeons need support and supervision during at least their first 20 gastrectomies. [ABSTRACT FROM AUTHOR]

Objective: This population-based study aimed to compare presentation, treatment allocation and survival of potentially curable esophageal cancer patients between Sweden and the Netherlands., Summary of Background Data: Identification of inter-country differences in treatment allocation and survival may be used for targeted esophageal cancer care improvement., Methods: Nationwide datasets were acquired from a Swedish cohort study and the Netherlands Cancer Registry. Patients with potentially curable (cT1-T4a/Tx, cN0/+, cM0/x) esophageal adenocarcinoma or squamous cell carcinoma (SCC) diagnosed in 2011-2015 were included. Multivariable logistic regression provided odds ratios (OR) for treatment allocation, and multivariable Cox model provided hazard ratios (HR) for overall survival, all with 95% confidence intervals (CI), adjusted for age, sex, year, tumor sub-location and stage., Results: Among 1980 Swedish and 7829 Dutch esophageal cancer patients, Swedish patients were older (71 vs 69 years, P <0.001) and had higher cT-stage (cT3: 49% vs 46%, P <0.001). After adjustment for confounders, Swedish patients were less frequently allocated to curative treatment (adenocarcinoma: OR=0.31, 95%CI 0.26-0.36; SCC: OR=0.28, 95%CI 0.22-0.36). Overall survival was lower in Swedish patients (adenocarcinoma: HR=1.36, 95%CI 1.27-1.46; SCC: HR=1.38, 95%CI 1.24-1.53), also when allocated to curative treatment (adenocarcinoma: HR=1.12, 95%CI 1.01-1.24; SCC: HR=1.34, 95%CI 1.14-1.59)., Conclusion: Swedish patients with potentially curable esophageal cancer were less frequently allocated to curative treatment, and showed lower survival compared to Dutch patients. The less pronounced inter-country survival difference after curative treatment suggests that the overall survival difference could at least partly be due to relative undertreatment of Swedish patients. Shared curative treatment thresholds across Europe may help improve survival of esophageal cancer patients., Competing Interests: Van Laarhoven has served as a consultant for BMS, Celgene, Lilly, Merck, Nordic, and Servier and has received unrestricted research funding from Bayer, BMS, Celgene, Lilly, Merck Serono, MSD, Nordic, Philips, Roche and Servier. Van Berge Henegouwen reports research grants from Olympus and Stryker, in addition to consulting fees from Medtronic, Mylan, Alesi Surgical and Johnson and Johnson. Verhoeven has received unrestricted research grants from BMS and Roche. The remaining authors have no conflict of interest to report. No funding was received for this study., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: It was hypothesized that patient survival improves with increasing surgeon age up to an age where it then decreases., Background: Experience, physical and psychological abilities required for esophagectomy may change with increasing surgeon age., Methods: This population-based cohort study included all patients having undergone esophagectomy for esophageal cancer in Sweden in 1987 to 2010, with follow-up until 2016. Risk-adjusted cumulative sum (RA-CUSUM) analysis was performed to estimate the relation between surgeon age and 90-day mortality, all-cause, and disease-specific 5-year mortality. Change-points in surgeon age identified by the RA-CUSUM were then analyzed in relation to mortality using multivariable Cox regression, providing hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for age, sex, comorbidity, tumor stage, tumor histology, neoadjuvant therapy, surgeon volume, and calendar year., Results: Among 139 surgeons performing 1761 esophagectomies, RA-CUSUM analysis of 90-day mortality showed change-points at 43 years (downward deflection) and at 56 years (upward deflection). Both all-cause and disease-specific 5-year mortality had corresponding change-points at 52 years and 56 years. Compared with surgeon age 52 to 55 years, surgeon age ≤51 years was associated with increased 90-day mortality (HR = 1.71, 95% CI 1.01-2.90) and 5-year all-cause mortality (HR = 1.21, 95% CI 1.02-1.43), and surgeon age ≥56 years showed increased 90-day mortality (HR = 2.38, 95% CI 1.38-4.13), 5-year all-cause mortality (HR = 1.29, 95% CI 1.08-1.55), and disease-specific 5-year mortality (HR = 1.18, 95% CI 1.01-1.42)., Conclusions: Surgeon age ≤51 and ≥56 years may increase short- and long-term mortality after esophagectomy for cancer.